Remdesivir plus Dexamethasone in COVID-19: A cohort study of severe patients requiring high flow oxygen therapy or non-invasive ventilation

Abstract

Introduction Remdesivir and Dexamethasone represent the cornerstone of therapy for critically ill patients with acute hypoxemic respiratory failure caused by Coronavirus Disease 2019 (COVID-19). However, clinical efficacy and safety of concomitant administration of Remdesivir and Dexamethasone (Rem-Dexa) in severe COVID-19 patients on high flow oxygen therapy (HFOT) or non-invasive ventilation (NIV) remains unknown. Materials and methods Prospective cohort study that was performed in two medical Intensive Care Units (ICUs) of a tertiary university hospital. The clinical impact of Rem-Dexa administration in hypoxemic patients with COVID-19, who required NIV or HFOT and selected on the simplified acute physiology score II, the sequential organ failure assessment score and the Charlson Comorbidity Index score, was investigated. The primary outcome was 28-day intubation rate; secondary outcomes were end-of-treatment clinical improvement and PaO2/FiO2 ratio, laboratory abnormalities and clinical complications, ICU and hospital length of stay, 28-day and 90-day mortality. Results We included 132 patients and found that 28-day intubation rate was significantly lower among Rem-Dexa group (19.7% vs 48.5%, p<0.01). Although the end-of-treatment clinical improvement was larger among Rem-Dexa group (69.7% vs 51.5%, p = 0.05), the 28-day and 90-day mortalities were similar (4.5% and 10.6% vs. 15.2% and 16.7%; p = 0.08 and p = 0.45, respectively). The logistic regression and Cox-regression models showed that concomitant Rem-Dexa therapy was associated with a reduction of 28-day intubation rate (OR 0.22, CI95% 0.05–0.94, p = 0.04), in absence of laboratory abnormalities and clinical complications (p = ns). Conclusions In COVID-19 critically ill patients receiving HFO or NIV, 28-day intubation rate was lower in patients who received Rem-Dexa and this finding corresponded to lower end-of-treatment clinical improvement. The individual contribution of either Remdesevir or Dexamethasone to the observed clinical effect should be further investigated.

The effect of non-invasive sequential ventilation treatment based on the use of an invasive ventilator on the arterial blood gas and inflammatory stress reaction in patients with severe pneumonia with respiratory failure

“…Non-invasive sequential ventilation treatments are simple to perform and cause less trauma to the body. Some studies have indicated that this type of therapy has little effect on the gastrointestinal tract and can effectively correct body hypoxia [17,18]. However, research has also proven that mechanical ventilation alone can be insufficient in terms of secretion drainage compensation, thus creating a limitation of its single application [19,20].…”

Hubungan Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, dan Ferritin dengan Pemberian Remdesivir pada Pasien Covid-19 dengan Peningkatan Transaminase

“…Pada penelitian tersebut, pasien diberikan antiinflamasi (deksametason dan aspirin), 21 sehingga faktor ini mungkin berperan dalam perbaikan kadar enzim hati. [22][23][24] Pemberian remdesivir tidak menjadi kontraindikasi absolut apabila nilai SGOT dan SGPT tidak melebihi 10 kali batas normal. 25 Kadar NLR, PLR, dan feritin sebelum terapi remdesivir juga terpantau lebih tinggi pada laki-laki dibandingkan perempuan.…”

Management of COVID-19 Pneumonia: Experience in a Peripheral Tertiary Level Hospital in Bangladesh

“…However, the study could not find conclusive results regarding adverse events or hospital-acquired bacterial infection rates due to its use. 14,24 In the index study, 97.1% of patients received systemic corticosteroids, mostly injectable dexamethasone. No comparative assessment could not be done between steroid and non-steroid recipients.…”