Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries

IMPORTANCE: Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES: To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS:The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES:Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES: The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS: Of 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE: Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)BACKGROUND: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. METHODS: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 >/= 0.60 during hyperoxemia). RESULTS: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). CONCLUSIONS: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. TRIAL REGISTRATION: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Caracterización física y nutricional de ingredientes concentrados en β-glucanos obtenidos de avenas (Avena sativa l.) chilenas y su comportamiento reológico en suspensiones acuosas e incorporados en masas elaboradas con harina de trigo

Tesis para optar al grado de Magíster en Ciencias de los AlimentosEn la actualidad, Chile se ubica dentro de los primeros lugares en los rankings de sobrepeso, obesidad y prevalencia de enfermedades cardiovasculares a nivel iberoamericano, lo que constituye una motivación para el desarrollo de alimentos con propiedades más saludables. En este sentido, el uso de fibras solubles, en especial de β-glucanos de cereales resulta una gran alternativa, puesto que además de poseer mensajes saludables aprobados a nivel nacional e internacional respecto a su contribución a la reducción del colesterol e impacto sobre la disminución del riesgo de enfermedades cardiovasculares; también se han estudiado sus efectos sobre la respuesta glucémica, salud digestiva y aumento de la sensación de saciedad, esto último impactando directamente al desarrollo de alimentos que puedan contribuir en el combate contra el sobrepeso y obesidad. En Chile, las barreras principales para la incorporación de los β-glucanos a alimentos procesados, además del desconocimiento de su existencia por parte de la población, es el impacto que pueden ocasionar en algunas etapas de los procesos de elaboración de ciertos alimentos, junto con el alto coste de los ingredientes concentrados en esta fibra soluble en el mercado. Por ello, cada vez se hace más importante contar con información basada en investigación que posibilite conocer el efecto que tiene la adición de ingredientes que contengan β-glucanos sobre propiedades físicas y nutricionales de productos. Este estudio trata acerca de la caracterización física-nutricional de ingredientes concentrados de β-glucanos obtenidos a partir de avenas chilenas (Avena sativa L.), un cultivo con gran potencial de revalorización en Chile; y su efecto sobre las propiedades de flujo en suspensiones acuosas y reología de masas elaboradas con harina de trigo. Para ello, se comenzó realizando una caracterización de 7 variedades de avenas chilenas para determinar la posible existencia de alguna(s) de ellas con ventajas comparativas sobre el contenido de esta fibra soluble, al concluir que ninguna de ellas tiene un contenido sobresaliente de β-glucanos, se consideró el uso de 2 ingredientes en polvo concentrados en β-glucanos (BG10 y BG15) obtenidos a partir de alguna de las variedades de avenas chilenas más disponibles en el mercado, para efectuar los ensayos experimentales posteriores. En primer lugar, se determinó la composición proximal y de otros hidratos de carbono complejos (contenido de fibra desglosado, almidones total y resistente y contenido de β-glucanos) en ambas muestras de ingredientes. Luego de ello, se determinaron algunas de sus propiedades físicas, tales como los parámetros estandarizados de color instrumental (L*, a*, b*, C* y hº), peso molecular (relacionado directamente con la acción bioactiva de los β-glucanos), y temperatura de transición vítrea (Tg). Posteriormente se determinaron las propiedades de flujo en suspensiones acuosas de estos ingredientes al 1% y 4% [m/v] a tres temperaturas (20, 50 y 80ºC) y la reología de masas modelo elaboradas con harina de trigo, a dos niveles de sustitución de esta última con los ingredientes BG10 y BG15; esto por medio de pruebas alveográficas, mixográficas/farinográficas y de reofermentación. La gran mayoría de los parámetros de composición (a excepción del contenido de cenizas y fibra dietética total) y físicos determinados en los dos ingredientes en estudio (BG10 y BG15) fueron estadísticamente distintos entre ellos: la determinación de todos los parámetros cromáticos fueron distintos entre ambos ingredientes, lo cual puede impactar en la aceptabilidad sensorial de ciertos alimentos a desarrollar con ellos. El peso molecular determinado en ambos ingredientes fue considerado alto (mayor a 3000 kDa), lo cual se relaciona con una alta bioactividad de los β-glucanos contenidos en estos ingredientes. Respecto a la determinación de Tg, el ingrediente BG10 presentó dos transiciones vítreas, mientras que el ingrediente BG15 no mostró dicha transición. Tanto BG10 como BG15 presentaron un impacto tanto sobre las propiedades de flujo de suspensiones acuosas (la gran parte de las suspensiones preparadas con ambos ingredientes mostraron comportamiento dilatante), como sobre la reología de masas elaboradas con harina de trigo, esto último respecto al comportamiento de masas sin la adición de los ingredientes BG10 y BG15. Por lo que se concluye que el impacto que posee la adición de ingredientes a base de β-glucanos sobre las propiedades físicas de sistemas acuosos y viscoelásticos (como lo son las masas), dependerá de su composición y de algunas de sus propiedades físicas, aspectos que hay que tener en cuenta al momento de desarrollar alimentos saludables que contengan β-glucano

Evolución de la rancidez oxidativa y la frescura del músculo de salmón coho (Oncorhynchus kisutch) alimentado con dietas adicionadas de antioxidantes naturales y conservado al estado congelado (-18[grados]C)

Memoria para optar al título de Ingeniero en AlimentosEn la actualidad, Chile se ubica en el segundo lugar de los rankings de producción de salmónidos a nivel mundial, lo que convierte al salmón en el producto alimenticio más importante de nuestras exportaciones pesqueras y en el principal motor económico de las regiones X y XI del país. Por ello, cada vez se hace más importante contar con nueva información basada en investigación, que sea capaz de responder y adelantarse a potenciales problemas, que posibilite el mejoramiento de la calidad de los salmónidos y de los productos derivados de ellos. El empleo de antioxidantes en las dietas para salmónidos es fundamental para retardar su deterioro, puesto que las materias primas principales que se emplean para elaborarlas son harina y aceite de pescado, insumos muy susceptibles a sufrir los ataques de la peroxidación lipídica. Los antioxidantes que se emplean actualmente para elaborarlas son, en su mayoría, compuestos de origen sintético cuya inocuidad está siendo cada vez más cuestionada a nivel internacional. Este estudio trata acerca del reemplazo de antioxidantes sintéticos por dos productos antioxidantes naturales inocuos (tocoferoles y extracto de romero (Rosmarinus officinalis)) en la dieta de Salmón coho (Oncorhynchus kisutch) de exportación y su efecto en la calidad del producto congelado durante 12 mese. Se consideró el empleo de 3 jaulas con salmones en cultivo de la Región X de Chile: los individuos de la primera jaula se alimentaron con la dieta control que contenía etoxiquina y BHT (Dieta I); los de la segunda se alimentaron con una dieta experimental que contenía un exceso de tocoferoles libre (Dieta II); y los de la tercera con otra dieta experimental que contenía una mezcla antioxidante de tocoferoles libres con extracto de romero (Dieta III), durante un tiempo de 80 días. Cumplido este tiempo, los salmones se sacrificaron y procesaron industrialmente, para obtener salmón congelado de exportación tipo HG y fueron enviados a Santiago para ser almacenados a -18º C y oportunamente analizados. Se analizaron cinco individuos con una frecuencia de 3 meses durante un año, a excepción de la composición proximal, que se efectuó en duplicado y solamente al inicio y al final del estudio. Los parámetros analizados periódicamente fueron: contenido de humedad, porcentaje de materia grasa, cuantificación de ácidos grasos poliinsaturados [omega]3, determinación del índice de polienos, índice de peróxidos, valor de p-ansidina, valor-pH, nitrógeno básico volátil total (NBVT), dimetilamina, formaldehído y cuantificación de tocoferoles libres. En las tres dietas empleadas en el estudio se determinó la composición proximal, el contenido de tocoferoles libres y la estabilidad oxidativa. Debido a que la gran mayoría de los parámetros de calidad analizados al utilizar las 3 dietas en estudio fueron estadísticamente equivalentes, y algunos incluso mejores con el empleo de las dietas experimentales; y a que ninguno de ellos fue afectado significativamente en forma negativa con las mismas, se concluye que el reemplazo de antioxidantes sintéticos por naturales en la dieta del Salmón coho (Oncorhynchus kisutch), es una alternativa factible a nivel técnico y recomendable si se desea ampliar el ingreso del salmón chileno a mercados cuyas tendencias estén a favor de una alimentación más natural y san

Histologically confirmed isolated IgG4-related hypophysitis: two case reports in young women

Summary IgG4-related hypophysitis is a recently described entity belonging to the group of IgG4-related diseases. Many other organs can also be affected, and it is more common in older men. To date, 32 cases of IgG4-related hypophysitis have been reported in the literature, 11 of which included confirmatory tissue biopsy and the majority affecting multiple organs. The aim of this report is to present two cases of biopsy-proven IgG4-related hypophysitis occurring in two young female patients with no evidence of involvement of other organs at the time of diagnosis. Learning points IgG4-related hypophysitis belongs to the group of IgG4-related diseases, and is a fibro-inflammatory condition characterized by dense lymphoplasmacytic infiltrates rich in IgG4-positive plasma cells and storiform fibrosis. It is more common in older men, but young women may also present this type of hypophysitis. Although involvement of other organs is frequent, isolated pituitary disease is possible. Frequent clinical manifestations include anterior hypopituitarism and/or diabetes insipidus. The diagnosis may be confirmed with any of the following criteria: a pituitary biopsy with lymphoplasmacytic infiltrates, with more than ten IgG4-positive cells; a sellar mass and/or thickened pituitary stalk and a biopsy-proven involvement of another organ; a sellar mass and/or thickened pituitary stalk and IgG4 serum levels &gt;140 mg/dl and sellar mass reduction and symptom improvement after corticosteroid treatment. Glucocorticoids are recommended as first-line therapy. </jats:sec

High- Versus Low-Dose Dexamethasone for the Treatment of COVID-19-related Acute Respiratory Distress Syndrome: A Multicenter and Randomized Open-label Clinical Trial

AbstractPurposeTo determine whether high-dose dexamethasone increases the number of ventilator-free days (VFD) among patients with acute respiratory distress syndrome due to coronavirus disease 2019 (C-ARDS)MaterialsA multicenter randomized controlled trial in adults with C-ARDS. Patients received 16 mg/d of dexamethasone intravenously for five days followed by 8 mg/d of dexamethasone for five days, or 6 mg/d of dexamethasone intravenously for 10 days.ResultsData from 98 patients who received at least one dose of dexamethasone were analyzed. At 28 days after randomization, there was no difference between high- and low-dose dexamethasone groups in VFD (median, 0 d [interquartile range (IQR) 0–14 d] versus 0 d [IQR 0–1 d]; P=0.231). The cumulative hazard of successful discontinuation from mechanical ventilation was increased by the high-dose treatment (adjusted sub-distribution hazard ratio: 1.84; 95% CI: 1.31 to 2.5; P&lt;0.001). None of the prespecified secondary and safety outcomes showed a significant difference between treatment arms.ConclusionsAmong patients with C-ARDS, the use of higher doses of dexamethasone compared with the recommended low-dose treatment did not show an increase in VFD. However, the higher dose significantly improved the time required to liberate them from the ventilatorClinical Trial Registered: NCT04395105</jats:sec