Randomized Open Investigation Determining Steroid Dose

Treatment for COVID-19 patients with respiratory failure has been vexing, but the use of steroids has shown promise. In a recent randomized control trial, dexamethasone 6 mg once daily showed a modest decrease in mortality among hospitalized COVID-19 patients who require oxygen supplementation or invasive mechanical ventilation. Other trials have shown that the inflammatory response to COVID-19 can be further attenuated at higher dosages of dexamethasone. These higher dosages have not been well studied and have not been directly compared to the current standard dose of dexamethasone 6 mg daily. We propose that a higher dexamethasone dose, equivalent to methylprednisolone 1 mg/kg/day which is routinely used to treat other inflammatory conditions of the lungs, may be more effective than the current standard dose in reducing mortality in COVID-19 patients with respiratory failure.

Inclusion criteria

• Adults greater or equal than 18 years old
• COVID-19 infection confirmed by positive PCR test
• Hypoxemia defined by an oxygen saturation < 94% or the need for supplemental oxygen

Exclusion criteria

• Corticosteroid use for > 48h within the past 15 days prior to enrollment
• Use of steroids with doses higher than the equivalent to dexamethasone 6 mg
• Use of immunosuppressive drugs
• Pregnant women
• Chronic oxygen use
• Known history of dexamethasone allergy
• DNR / DNI
• Patient or proxy cannot consent