it looks like all the love for dexamethasone may have melted the server... for now you can find the post on google docs here:https://drive.google.com/file/d/1JqgrInYTl9hbcHvSsh7i4igqFLh1FzJ0/view?usp=sharing …
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Please, i ask many experts this question no body replies, if i have a hypoxemic patient and i have Actemra, dexamethaone, remdisivir, what to do!!
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dexamethasone plus remdesivir would be my choice for now.
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Not completely sure what do you mean by standard of care? Although it’s true sounds promising there is still much to be known. What we the Apache/SOFA scores of these patients? Did they all completed the course with dexamethasone?
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At what time during the progression of the disease was it started. Also where do you get that you can replace with other steroids? I find no evidence in this study suggesting this.
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Thanks for the shoutout to the other steroids! Dex on shortage :(
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Are we going to have any dex for the next year or two now?
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hopefully folks are ramping up production. dex will run out but we can substitute with other steroids (this is the beauty of steroids compared with drugs like tocilizumab which cant be substituted for)
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What do you think about the 40% mortality in this study compared to the ~25% in ACT? We've extrapolated ARDS methylpred 40q8 for most of our patients in the MICU and SD and are unsure about changing practice completely based on this study. When would you use more steroids?
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might consider higher than 6mg dex in patients with really high inflammatory markers or deterioration despite 6mg
some studies ongoing to look at this
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FOAMite
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now standard of care for hypoxemic & intubated patients (but *not* patients requiring no oxygen support)