pediatric patients with covid-19 who need mechanical ventilation
Background information
The COVID-19 pandemic has spread in all parts of the world since the first incidences were recorded in China at the end of 2019. Notably, the world had recorded more than 1.2 million infections by the end of July 2020, and 550,000 individuals succumbing to the disease. It affects people of all ages. However, those above 60 years are at a higher risk. Since evidence of patients developing a systematic inflammatory response which can be catastrophic to the lungs leading to multisystem dysfunction, it has been suggested that the anti-inflammatory effects of corticosteroids may prevent these harmful impacts. Specifically, dexamethasone, as a corticosteroid, has been widely recommended. Accordingly, the drug is administered through an injection. Dexamethasone 3.3 mg/ml solution for injection may be given by the intramuscular, intraarticular, or direct intravenous injection, intravenous infusion, or soft tissue infiltration. Despite the drug’s effectiveness, caution is needed when administered to patients below 18 years. Additionally, it may be useful for pediatric patients with covid-19 who need mechanical ventilation.
specific guideline recommendation
According to Coronavirus Disease 2019 (COVID-19) Treatment Guidelines Panel, the use of corticosteroids, mostly dexamethasone, has been critical in reducing death risk. The drug has been experimented in critically sick patients with acute respiratory distress syndrome (ARDS), where 851 patients were examined. This survey’s findings established that corticosteroid therapy decreased the probability of all-cause mortality and mechanical ventilation duration. Moreover, recommendations for the utilization of dexamethasone for covid-19 are greatly pegged on data from recovery trials done in the United Kingdom. The trial consisted comparison of the patients administered with dexamethasone for ten days and those that received standard of care. Notably, there was higher mortality after 28 days among those who received the standard of care compared to those randomized to receive dexamethasone. Additionally, this benefit was also witnessed in the sick individuals that mechanically required ventilators and supplemental oxygen at enrollment.
literature to support the guideline recommendation
The article’s objective was to inform clinicians on the best way to care for the individuals affected by covid-19. Outstandingly, the recommendations from the guidelines were pegged on scientific proof and expert opinion. The study on dexamethasone comprised 6,425 participants, where 2104 were administered with dexamethasone plus standard of care while 4,321 received standard of care alone. The latter was the control group. From the results, 22.9% of those under the dexamethasone group died within 28 days of the survey randomization compared to 25.7% who received standard of care alone. Additionally, the mortality was lower in the dexamethasone group than the usual care group for the sick receiving invasive mechanical ventilator. Moreover, there was a lack of survival evidence among patients that did not need oxygen therapy during enrollment; the fatality among patients using dexamethasone was 17.8% compared to 14.0% for those in the standard care group. Hence, in the individuals hospitalized with covid-19, dexamethasone utilization led to lower mortality after 28 days among the sick receiving either invasive mechanical ventilation or oxygen alone at randomization.
Conclusion
In summary, the COVID-19 pandemic has spread and is present in various parts of the world. All persons are at risk of being affected. However, studies have recommended dexamethasone as one of the drugs that reduce the mortality rate among covid patients. There has been evidence of reduced fatalities among patients using the drug compared to those on the standard of care, implying that it is effective. Therefore, clinicians around the world need to include dexamethasone when attending to covid-19 patients.