#Trials fusion path to enlightenment trial
The essence of these trials might be highlighted by the larger ARDSNet trial (Steinberg 2006), which demonstrated increased ventilator free days and shock free days with corticosteroids but no difference in the primary outcome of mortality at 60 days. Different drugs (mostly hydrocortisone and methylprednisolone) administered in different time-points of the disease (early vs late) were investigated. How about ARDS? Pneumonia? Viral diseases?īefore discussing the role of corticosteroids in COVID-19, we will discuss some evidence of the pre-COVID-19 era.Ī series of trials in late 90s and early 00s investigated the role of corticosteroids for ARDS. For chronic pulmonary obstructive lung disease? Always. For refractory septic shock? Why not (Venkatesh 2018 Annane 2018).
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Corticosteroids for traumatic brain injury? Not effective (Roberts 2004). However, looking at published data, we have more doubts than certainties. We have been using corticosteroids in critical care for more than 50 years (McConn 1971). From hydroxychloroquine to convalescent plasma, lopinavir/ritonavir, ivermectin and tocilizumab had their chance, unfortunately without any real success until now. And with all science misinterpretation, the COVID-19 pandemic was a fertile field for clinical trials and a real time lesson on how low-quality evidence can be detrimental. But was that enough? Probably not.Īn overwhelming number of possible repurposing therapeutic drugs begin to pop-up.
#Trials fusion path to enlightenment how to
Fortunately, we know how to support ARDS patients: lung protective ventilation (Brower 2000), prone position (Guérin 2013) and neuromuscular blocking agents (Papazian 2010 Moss 2019) are all well known to intensivists. Shortly after the COVID-19 outbreak, it was clear that we would face a tsunami of viral pneumonia leading to acute respiratory distress syndrome (ARDS). However, we’d like to move backwards to a moment when there was only uncertainty and possibilities. It may seem unnecessary to discuss the use of corticosteroids in critically ill patients with COVID-19 when high-quality evidence (Horby 2020 Sterne 2020) is available. But within each old map there were tips pointing to the true north.
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Of course! They were pre-COVID-19 era maps, ancient history for some. All the maps we had pointed out to the other direction. Really? Was the path that clear? We are afraid not. And it took only a few seconds after we touched land to hear some sailors whispering that they all knew the way to the corticosteroids harbour and that all maps pointed to its direction. The first drug to decrease mortality in critically ill COVID-19 patients. M ore than six months riding treacherous waves in the COVID-19 storm had passed until a glimpse of a rudimentary old harbour appeared.