Effect of Dexamethasone Use on Prevention of Positive Pressure Ventilation Among COVID-19 Patients

Abstract

Background: Acute respiratory failure (ARF), a common complication of COVID-19, often necessitates supplemental oxygen and higher respiratory support. Due to their anti-inflammatory properties, corticosteroids have been used as potential treatment for patients with ARF. Previous research demonstrated that use of dexamethasone in COVID-19 patients effectively reduced the 28-day mortality in those receiving oxygen without mechanical ventilation. As a result, dexamethasone became a standard of care at some hospitals for COVID-19 patients needing supplemental oxygen. This study investigated the effect of dexamethasone use on the need for positive pressure ventilation (PPV).

Methods: This is a retrospective chart review of adult patients with confirmed COVID-19 who received supplemental oxygen during hospital stay at an academic medical center from May 2020 through October 2020. The study protocol was approved by the IRB. The study outcomes included the use of PPV (invasive or noninvasive ventilation), hospital mortality, hospital LOS, and requirement of ICU admission during hospital stay. Study outcome data was analyzed using the Student’s T-test/ Mann-Whitney test for continuous and Chi-square test for categorical variables via SPSS software. P-value < .05 was considered significant.

Results: A total of 534 subjects [median age = 58 y; male 297 (55.6%); Hispanic/Latino 263 (49.3%); median BMI = 31.6] were included in the analysis. Of these, 206 (38.6%) received dexamethasone during hospital admission and median time to start dexamethasone from the start of oxygen was 10 (IQR 3.8-26) h. The study groups did not differ in terms of age (P = .13), gender (P = .66) or BMI (P = .067) but differed in terms of race/ethnicity (P = .002). There was no difference between the study groups in terms of HR (P = .87), frequency (P = .39), S/F ratio (P = .67) or SOFA score (P = .059) at the admission. During hospital stays, those who received dexamethasone were more likely to be placed on PPV (25.7% vs 18%; P = .038) as compared to those who did not receive dexamethasone. A significantly higher proportion of subjects in the dexamethasone group required ICU admission (56.8% vs 44.8%; P = .008). The study groups did not differ in terms of hospital mortality (8.7% vs 10.4%; P = .55), but dexamethasone group spent significantly more days in the hospital (7 vs 6; P = .02).

Conclusions: This retrospective study found that administering dexamethasone to COVID-19 patients requiring supplemental oxygen did not reduce the need for PPV.