Daily Ards Research Analysis

BACKGROUND: COVID-19, caused by SARS-CoV-2, leads to severe respiratory complications, often requiring intensive care. Corticosteroids have been widely used to manage inflammation in COVID-19 patients, with dexamethasone and methylprednisolone being among the most commonly administered options. However, their relative efficacy remains a subject of debate. This study aimed to compare the effectiveness of dexamethasone and methylprednisolone in hospitalized COVID-19 patients. METHODS: This double-blind, randomized controlled trial was conducted at Imam-Ali Hospital, Karaj, Iran, on 300 hospitalized COVID-19 patients. Patients were randomly assigned to receive either intravenous dexamethasone (8 mg twice daily) or pulse methylprednisolone (500 mg daily for three days), in addition to standard COVID-19 management. The primary outcomes included mortality rate, ICU length of stay, and the need for mechanical ventilation. Secondary outcomes involved blood oxygen saturation (SpO₂) levels. Statistical analyses were performed using SPSS (version 26). RESULTS: The study included 150 patients in each treatment group. The mortality rate was 12.6% in the dexamethasone group and 15.3% in the methylprednisolone group, with no statistically significant difference (RR: 0.82, P = 0.50). The need for mechanical ventilation was observed in 16.6% of patients in the dexamethasone group and 21.3% in the methylprednisolone group, also without a significant difference (RR: 0.78, P = 0.30). However, ICU stay was significantly shorter in the dexamethasone group (9.5 days) compared to the methylprednisolone group (11.3 days) (P < 0.001). No significant differences were noted in SpO₂ levels between the two groups. CONCLUSION: Both dexamethasone and methylprednisolone demonstrated similar efficacy in outcomes such as mortality rate need for mechanical ventilation in hospitalized COVID-19 patients. However, dexamethasone was associated with a significantly shorter ICU stay, suggesting a potential advantage in hospitalization duration. Further research is needed to refine corticosteroid use and explore additional immunomodulatory strategies to improve COVID-19 outcomes.

Mechanical ventilation is a life support system for patients with acute respiratory distress syndrome (ARDS). As part of strategies to protect the lung during ventilation, plateau pressure can be determined via an end-inspiratory pause; however, there is no agreed-upon pause duration in medical protocols. Mechanical ventilation can be modelled using the Viscoelastic model (VEM) for respiration. The identification of static compliance is of clinical interest, as it can be used to estimate plateau pressure. Practical identifiability analysis quantifies the confidence with which model parameters can be estimated from finite, noisy data. This paper evaluates the robustness of plateau pressure estimates in clinical data by analysing practical identifiability of the VEM identified in data with varying durations of end expiratory pauses. Profile likelihood and Hamiltonian Monte Carlo (HMC) simulations were used to determine estimation robustness. The methods were applied to mechanical ventilation data from a previous ARDS study. Profile likelihood and HMC showed strong agreement in both parameter estimates and identifiability results with similar confidence distributions. Both methods demonstrated a loss of parameter robustness that would preclude clinical utility when the end expiratory pause was reduced. By quantifying the confidence in parameter estimation and finding trade-offs in parameters that may be previously unknown when parameters are estimated, the methods give insight into the certainty of the estimate and parameter behaviours, even when the model fits the data well.

BACKGROUND: Administering antenatal corticosteroids (ACS) to those at risk for early-preterm delivery has been widely recommended, yet the evidence regarding twin pregnancies remains insufficient and controversial. METHODS: This 8-year retrospective cohort study analyzed twin pregnancies at risk for early preterm birth (24 + 0 to 33 + 6 weeks of gestation) in a university-affiliated hospital in China from 2013 to 2020. Propensity score overlap weighting was used to analyze the association between ACS administration and the risk of neonatal outcomes. The primary outcome was the composite neonatal respiratory morbidity, defined as at least one of the following: postnatal occurrences respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. RESULTS: The study population consisted of 277 individuals with twin pregnancies, including 221 (79.8%) who received corticosteroids during 24 + 0 to 33 + 6 weeks of gestation as ACS group, and 56 (20.2%) who did not as no-ACS group. The propensity score overlap weighting showed no significant differences in the risk of neonatal primary outcome (161 [72.9%] vs. 40 [71.4%], weighted OR, 1.07[95% CI, 0.40-2.91]) between the two groups. None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of year of delivery, advanced maternal age, parity, assisted reproductive technology, gestational diabetes mellitus, hypertensive disorders in pregnancy, gestational age at delivery, mode of delivery, chorionicity, intertwin growth discordance and infant sex, and neither was the sensitive analysis of using propensity score matching, different administration-to-birth interval, and treating twin infants as individuals. CONCLUSION: In this retrospective cohort study, no significant association was observed between ACS administration during the early-preterm period in twin pregnancies and a decreased risk of newborn morbidity. Further research is necessary to determine whether the same ACS regimen for twin pregnancies should be recommended in the real world as it is for singletons.