Early Dexamethasone Use as A Protective Measure In Non-Mechanically Ventilated Critically Ill Patients With COVID-19: A Multicenter, Cohort Study
Background: Dexamethasone showed mortality benefits in COVID-19 patients. However, the optimal timing for dexamethasone initiation to prevent COVID-19 consequences such as respiratory failure requiring MV is debatable. As a result, the purpose of this study is to assess the impact of early dexamethasone initiation in non-MV critically ill patients with COVID19.Methods: A multicenter cohort study including adult patients with COVID-19 admitted to intensive care units (ICUs) and received systemic
... dexamethasone between March 2020 and March 2021. Patients were categorized into two groups based on the timing for dexamethasone initiation (early vs. late). The primary endpoint is developing respiratory failure that required MV; other outcomes were considered secondary. Propensity score matching was used based on the patient's SOFA score, mechanical ventilation (MV) status, prone status, and early use of tocilizumab within 24 hours of ICU admission.Results: Among 208 patients matched using propensity score, 104 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 2.75 [1.12, 6.76], P=0.02). Additionally, late use was associated with longer hospital LOS (Est. [95%CI]: 0.55 [0.22, 0.88], P=0.001).The 30-day and in-hospital mortality were higher in the late group; however, were not statistically significant.Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 might be considered a proactive protective measure in non-mechanically ventilated patients.