-
Je něco špatně v tomto záznamu ?
Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis
MW. Munch, A. Granholm, J. Maláska, J. Stašek, PO. Rodriguez, T. Pitre, R. Wilson, J. Savović, B. Rochwerg, A. Svobodnik, M. Kratochvíl, M. Taboada, V. Jha, BKT. Vijayaraghavan, SN. Myatra, B. Venkatesh, A. Perner, MH. Møller
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu metaanalýza, systematický přehled, časopisecké články, přehledy
Grantová podpora
National Institute for Health Research Applied Research Collaboration West
E-22703-06
Rigshospitalet's Research Council
Weston NHS Foundation Trust
Department of Health and Social Care
LM2023049
MEYS LRI CZECRIN
65269705
FNBr
PubMed
37881881
DOI
10.1111/aas.14346
Knihovny.cz E-zdroje
- MeSH
- COVID-19 * MeSH
- dexamethason škodlivé účinky MeSH
- dospělí MeSH
- farmakoterapie COVID-19 MeSH
- hypoxie MeSH
- lidé MeSH
- pacienti MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
BACKGROUND: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia. METHODS: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy. CONCLUSIONS: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.
2nd Department of Anaesthesiology University Hospital Brno Brno Czech Republic
Collaboration for Research in Intensive Care Copenhagen Denmark
Department of Critical Care Medicine Apollo Hospitals Chennai India
Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Intensive Care Medicine Wesley Hospital Brisbane Queensland Australia
Department of Medicine McMaster University Hamilton Ontario Canada
Department of Pharmacology CZECRIN Faculty of Medicine Masaryk University Brno Czech Republic
Department of Simulation Medicine Faculty of Medicine Masaryk University Brno Czech Republic
Population Health Sciences Bristol Medical School University of Bristol Bristol England
Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
Pulmonary and Critical Care Medicine Instituto Universitario CEMIC Buenos Aires Argentina
School of Public Health Imperial College London UK
The George Institute for Global Health New Delhi India
The George Institute for Global Health Sydney New South Wales Australia
Citace poskytuje Crossref.org
- 000
- 00000naa a2200000 a 4500
- 001
- bmc24007424
- 003
- CZ-PrNML
- 005
- 20240423155939.0
- 007
- ta
- 008
- 240412s2024 enk f 000 0|eng||
- 009
- AR
- 024 7_
- $a 10.1111/aas.14346 $2 doi
- 035 __
- $a (PubMed)37881881
- 040 __
- $a ABA008 $b cze $d ABA008 $e AACR2
- 041 0_
- $a eng
- 044 __
- $a enk
- 100 1_
- $a Munch, Marie Warrer $u Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $1 https://orcid.org/0000000311279599
- 245 10
- $a Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis / $c MW. Munch, A. Granholm, J. Maláska, J. Stašek, PO. Rodriguez, T. Pitre, R. Wilson, J. Savović, B. Rochwerg, A. Svobodnik, M. Kratochvíl, M. Taboada, V. Jha, BKT. Vijayaraghavan, SN. Myatra, B. Venkatesh, A. Perner, MH. Møller
- 520 9_
- $a BACKGROUND: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia. METHODS: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy. CONCLUSIONS: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.
- 650 _2
- $a dospělí $7 D000328
- 650 _2
- $a lidé $7 D006801
- 650 12
- $a COVID-19 $7 D000086382
- 650 _2
- $a farmakoterapie COVID-19 $7 D000093485
- 650 _2
- $a pacienti $7 D010361
- 650 _2
- $a dexamethason $x škodlivé účinky $7 D003907
- 650 _2
- $a hypoxie $7 D000860
- 655 _2
- $a metaanalýza $7 D017418
- 655 _2
- $a systematický přehled $7 D000078182
- 655 _2
- $a časopisecké články $7 D016428
- 655 _2
- $a přehledy $7 D016454
- 700 1_
- $a Granholm, Anders $u Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $1 https://orcid.org/0000000157997655
- 700 1_
- $a Maláska, Jan $u Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic $u Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic $u 2nd Department of Anaesthesiology University Hospital Brno, Brno, Czech Republic $1 https://orcid.org/0000000269112575
- 700 1_
- $a Stašek, Jan $u Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 700 1_
- $a Rodriguez, Pablo O $u Pulmonary and Critical Care Medicine, Instituto Universitario CEMIC (Centro de Educación Médica e Investigación Clínica), Buenos Aires, Argentina
- 700 1_
- $a Pitre, Tyler $u Department of Medicine, McMaster University, Hamilton, Ontario, Canada $u Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- 700 1_
- $a Wilson, Rebecca $u Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England $u NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- 700 1_
- $a Savović, Jelena $u Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England $u NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- 700 1_
- $a Rochwerg, Bram $u Department of Medicine, McMaster University, Hamilton, Ontario, Canada $u Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- 700 1_
- $a Svobodnik, Adam $u Department of Pharmacology/CZECRIN, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 700 1_
- $a Kratochvíl, Milan $u Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 700 1_
- $a Taboada, Manuel $u Department of Anaesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Santiago, Spain
- 700 1_
- $a Jha, Vivekanand $u The George Institute for Global Health, New Delhi, India $u School of Public Health, Imperial College, London, UK $u Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- 700 1_
- $a Vijayaraghavan, Bharath Kumar Tirupakuzhi $u The George Institute for Global Health, New Delhi, India $u Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
- 700 1_
- $a Myatra, Sheila Nainan $u Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India $1 https://orcid.org/000000016761163X
- 700 1_
- $a Venkatesh, Balasubramanian $u The George Institute for Global Health, Sydney, New South Wales, Australia $u Department of Intensive Care Medicine, Wesley Hospital, Brisbane, Queensland, Australia $u University of Queensland, Brisbane, Queensland, Australia
- 700 1_
- $a Perner, Anders $u Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $1 https://orcid.org/0000000246680123
- 700 1_
- $a Møller, Morten Hylander $u Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $1 https://orcid.org/0000000263789673
- 773 0_
- $w MED00000016 $t Acta anaesthesiologica Scandinavica $x 1399-6576 $g Roč. 68, č. 2 (2024), s. 146-166
- 856 41
- $u https://pubmed.ncbi.nlm.nih.gov/37881881 $y Pubmed
- 910 __
- $a ABA008 $b sig $c sign $y - $z 0
- 990 __
- $a 20240412 $b ABA008
- 991 __
- $a 20240423155936 $b ABA008
- 999 __
- $a ok $b bmc $g 2081417 $s 1217191
- BAS __
- $a 3
- BAS __
- $a PreBMC-MEDLINE
- BMC __
- $a 2024 $b 68 $c 2 $d 146-166 $e 20231026 $i 1399-6576 $m Acta anaesthesiologica Scandinavica $n Acta Anaesthesiol Scand $x MED00000016
- GRA __
- $p National Institute for Health Research Applied Research Collaboration West
- GRA __
- $a E-22703-06 $p Rigshospitalet's Research Council
- GRA __
- $p Weston NHS Foundation Trust
- GRA __
- $p Department of Health and Social Care
- GRA __
- $a LM2023049 $p MEYS LRI CZECRIN
- GRA __
- $a 65269705 $p FNBr
- LZP __
- $a Pubmed-20240412
