概括
高剂量的皮质类固醇并没有降低接受呼吸系统支持的住院COVID-19患者的死亡率. 在RECOVERY试验中,与通常护理相比,28天死亡率没有显著差异. 这表明更高的剂量对这个患者群体没有好处.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 低剂量皮质类固醇 (例如,6毫克德甲) 改善了缺氧COVID-19患者的结果.
- 高剂量的皮质类固醇在临床缺氧的非通风患者中已经显示出危害.
- 在需要呼吸器支持的患者中,高剂量皮质类固醇的疗效和安全性仍然不确定.
研究的目的:
- 为了评估高剂量皮质类固醇与在接受呼吸器支持的住院COVID-19患者的常规护理的疗效和安全性.
- 确定对28天死亡率和其他关键临床结果的影响.
主要方法:
- 随机的,受控的,开放标签的平台试验 (RECOVERY).
- 接受呼吸器支的成人COVID-19患者被随机分配 (1:1) 接受常规护理加上高剂量的皮质类固醇或仅接受常规护理.
- 主要结局:28天死亡率. 二次结果:住院时间,需要侵入性机械通风或死亡.
主要成果:
- 高剂量皮质类固醇组 (35%) 和常规护理组 (37%) 在28天死亡率上没有显著差异 (RR 0.87;p=0.37).
- 在28天的医院出院率中没有显著差异 (52%对52%).
- 在基线不接受侵入性通风的人群中,复合终点的侵入性机械通风或死亡没有明显减少 (37%与45%相比; p=0.05).
结论:
- 高剂量的皮质类固醇在接受呼吸系统支持的COVID-19患者中没有显示出死亡率的好处.
- 通常的护理,包括低剂量的皮质类固醇,仍然是这种患者群体的标准.
- 可能需要进一步的研究来完善在关键COVID-19护理中的皮质类固醇策略.
更多相关视频
09:36Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
2.7K
04:56In Vitro Method to Control Concentrations of Halogenated Gases in Cultured Alveolar Epithelial Cells
Published on: October 23, 2018
6.5K
相关概念视频
COPD: Management Using Bronchodilators and Corticosteroids
170
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
170
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
201
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
201
Acute Respiratory Failure-V
113
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
113
Pulmonary Tuberculosis I
215
Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
215
Pneumonia IV: Management
286
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
286
Acute Respiratory Failure-II
158
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
158
