| Title: |
High-Dose Dexamethasone and Oxygen Support Strategies in Intensive Care Unit Patients With Severe COVID-19 Acute Hypoxemic Respiratory Failure |
| Authors: |
Bouadma, Lila; Mekontso-Dessap, Armand; Burdet, Charles; Merdji, Hamid; Poissy, Julien; Dupuis, Claire; Guitton, Christophe; Schwebel, Carole; Cohen, Yves; Bruel, Cedric; Marzouk, Mehdi; Geri, Guillaume; Cerf, Charles; Mégarbane, Bruno; Garçon, Pierre; Kipnis, Eric; Visseaux, Benoit; Beldjoudi, Naima; Chevret, Sylvie; Timsit, Jean-François; Alloux, Céline; Amerali, Fadila; Andriss, Béatrice; Baghli, Kamyl; Brocvielle, Hélène; Capelle, Florence; Chibane, Ines; Dalibey, Sarra; Ettalhaoui, Nadia; Lamri, Sabrine; Maurer, Yohan; Mintsa, Jean-Marc; Oubahim, Alice; Tellier, Marie-Capucine; Zemihi, Imane; Abdel-Nabey, Moustafa; Azzouguen, Billal; Belkessa, Ghenima; de Montmollin, Etienne; Deiler, Veronique; Fallet, Aline; Franchineau, Guillaume; Girard, Tiphaine; Grinea, Alexandra; Jaquet, Pierre; Kramer, Laura; Lamara, Fariza; Lefevre, Lucie; Patrier, Juliette; Presente, Simona; Sayagh, Faiza; Sinnah, Fabrice; Sonneville, Romain; Wicky, Paul-Henri; Zmihi, Sylia; Barget, Nathalie; Belmokhtar, Rawan; Brahmi, Sabrina; Djabra, Naoual; Ebstein, Nathan; Fliss, Souha; Gourbdji, Amina; Juguet, William; Messani, Fadhila; Rambaud, Thomas; Rathouin, Vanessa; Rebai, Mani; Rigal, Marthe; Schmidt, Julien; Soulie, Marie; Tandjaoui-Lombiotte, Yacine; Winchenne, Anaïs; Ziol, Marianne; Arrestier, Romain; Bagate, François; Benais, Morgan; Bendib, Ines; Lan, Le; Benelli, Brice; Berti, Enora; Bertier, Astrid; Carteaux, Guillaume; Carvalho, Muriel; Cavaleiro, Pedro; Deprost, Nicolas; Hartman, Otto; Haudebourg, Anne-Fleur; Le Febvre de Nailly, Delphine; Lopinto, Julien; Mahiou, Sabrina; Masi, Paul; Michaud, Gaël; Nait-Chabane, Luiza; Ouali, Fariza; Perier, François; Razazi, Keyvan; Sadaoui, Thiziri; Thiemele, Alaki; Tuffet, Samuel; Autron, Flavien; Boddaert, Pauline; Brice, Sylvie; Caplan, Morgan; Cerf, Amélie; Cousin, Nicolas; Cuvelliez, Marie; Delcourte, Claire; Durand, Arthur; Favory, Raphaël; El Kalioubie, Ahmed; Gaudel, Myrtille; Gaudet, Alexandre; Goutay, Julien; Houard, Marion; Jaillette, Emmanuelle; Jourdain, Mercé; Ledoux, Geoffrey; Mariller, Laure; Millot, Guillaume; Moreau, Anne-Sophie; Niles, Christopher; Nseir, Saad; Onimus, Thierry; Preau, Sébastien; Roucou, Aurélie; Rouze, Anahita; Saura, Ouriel; Simonnet, Arthur; Tortuyaux, Romain; Allam, Hayat; Cattelan, Jessy; Clere-Jehl, Raphaël; Helms, Julie; Hilt, Kévin; Hutt-Clauss, Anne; Kummerlen, Christine; Meziani, Ferhat; Monnier, Alexandra; Rahmani, Hassène; Studer, Antoine; Thiebaut, Leonie; Han Hew Wai, Aurélie; Cortier, David; Devaquet, Jérôme; Fremont, Dimitri; Galliot, Richard; Juster, Fabienne; Le Marchand, Mathilde; Le Meur, Lucie; Neuville, Mathilde; Roux, Emmanuel; Tachon, Guillaume; Vassord-Dang, Camille; Zuber, Benjamin; Bruel, Cédric; Aroulanda, Marie-José; Berthet-Delteil, Bryan; Courtiade-Malher, Juliette; de Chevigny, Alix; Fontaine, Candice; Fournier, Julien; Garrigou, Sonia; Jardin-Szucs, Meryam; Philippart, François; Renet, Sophie; Sacco, Emmanuelle; Tran, Marc; Bolle, Delphine; Callahan, Jean-Christophe; Chudeau, Nicolas; Darreau, Cédric; Guillarme, Séverine; Landais, Mickael; Latrouite, Laurent; Le Moal, Charlène; Lebasnier, Eliott; Leroyer, Marie-Hélène; Marnai, Rémy; Meunier, Juliette; Naveau, Catherine; Saint-Martin, Marjorie; Robert, Alain; Tirot, Patrice; Bougnaud, Joanna; Candille, Clara; Collomb-Muret, Roselyne; Cordier, Charlotte; Galerneau, Louis-Marie; Gerard, Côme; Nicolas, Pierre; Refes, Amel; Rigault, Guillaume; Sigaud, Florian; Terzi, Nicolas; Terzi, Ester; Turbil, Emmanuelle; Vallod, Yann; Adda, Mireille; Bachelier, Claire; Bereiziat, Marine; Bernard, Lise; Bouzgarrou, Radhia; Calvet, Laure; Couhault, Pierre; Coupez, Elisabeth; Duee, Frédéric; Gilard, Armelle; Grapin, Kévin; Kinda, Francis; Laurichesse, Guillaume; Liteaudon, Jean-Mathias; Souweine, Bertrand; Thouy, François; Declercq, Hervé; Descamps, Dominique; Dewatine, Anne; Janowski, Sabine; Senis, Catherine; Vinsonneau, Christophe; Bignon, Anne; Bommenel, Tchadie; Huriez, Claude; Duprey, Matthieu; Garcon, Pierre; Hammami, Afef; Issad, Andréa; Jaccod-Deneuville, Marie-Odile; Kachmar, Safaâ; Van-Vong, Ly; Zarka, Jonathan; Deye, Nicolas; Jacob, Aude; Malissin, Isabelle; M’rad, Aymen; Voicu, Sebastian; Chambrin-Lauvray, Hélène; Douache, Ouarda; Godement, Mathieu; Jouffroy, Romain; Jullien, Edouard; Petit, Matthieu; Vieillard-Baron, Antoine; Cariou, Alain; Boyer, Alexandre; Pavese, Patricia; Giraudeau, Bruno |
| Contributors: |
Service de Médecine Intensive et Réanimation Strasbourg; Centre Hospitalier Universitaire Strasbourg (CHU Strasbourg); Hôpitaux Universitaires de Strasbourg (HUS)-Hôpitaux Universitaires de Strasbourg (HUS); Nanomédecine Régénérative (NanoRegMed); Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM); Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF); Université de Lille-Centre National de la Recherche Scientifique (CNRS); Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S 1144 / U1144)); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité); Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL); Institut Pasteur de Lille; Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS); Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE); Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille) |
| Source: |
ISSN: 2168-6106. |
| Publisher Information: |
CCSD; American Medical Association |
| Publication Year: |
2022 |
| Subject Terms: |
[SDV]Life Sciences [q-bio]; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases; [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases; [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract; [SDV.TOX]Life Sciences [q-bio]/Toxicology |
| Description: |
International audience ; Importance : The benefit of high-dose dexamethasone and oxygenation strategies vs standard of care for patients with severe acute hypoxemic respiratory failure (AHRF) caused by COVID-19 pneumonia is debated.Objectives : To assess the benefit of high-dose dexamethasone compared with standard of care dexamethasone, and to assess the benefit of high-flow nasal oxygen (HFNo2) or continuous positive airway pressure (CPAP) compared with oxygen support standard of care (o2SC).Design, Setting, and Participants : This multicenter, placebo-controlled randomized clinical trial was conducted in 19 intensive care units (ICUs) in France from April 2020 to January 2021. Eligible patients were consecutive ICU-admitted adults with COVID-19 AHRF. Randomization used a 2 × 3 factorial design for dexamethasone and oxygenation strategies; patients not eligible for at least 1 oxygenation strategy and/or already receiving invasive mechanical ventilation (IMV) were only randomized for dexamethasone. All patients were followed-up for 60 days. Data were analyzed from May 26 to July 31, 2021.Interventions : Patients received standard dexamethasone (dexamethasone-phosphate 6 mg/d for 10 days [or placebo prior to RECOVERY trial results communication]) or high-dose dexamethasone (dexamethasone-phosphate 20 mg/d on days 1-5 then 10 mg/d on days 6-10). Those not requiring IMV were additionally randomized to o2SC, CPAP, or HFNo2.Main Outcomes and Measures : The main outcomes were time to all-cause mortality, assessed at day 60, for the dexamethasone interventions, and time to IMV requirement, assessed at day 28, for the oxygenation interventions. Differences between intervention groups were calculated using proportional Cox models and expressed as hazard ratios (HRs).Results : Among 841 screened patients, 546 patients (median [IQR] age, 67.4 [59.3-73.1] years; 414 [75.8%] men) were randomized between standard dexamethasone (276 patients, including 37 patients who received placebo) or high-dose dexamethasone (270 ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1001/jamainternmed.2022.2168 |
| Availability: |
https://hal.science/hal-04399061; https://doi.org/10.1001/jamainternmed.2022.2168 |
| Accession Number: |
edsbas.B903D38C |
| Database: |
BASE |