83. RFJC 13 – ARDS Series – DEXA-ARDS

The DEXA-ARDS trial, published in *Lancet Respiratory Medicine* in 2020, evaluates the efficacy of dexamethasone in treating moderate to severe acute respiratory distress syndrome. Administering 20 milligrams of dexamethasone daily for five days followed by 10 milligrams for another five days significantly reduces 60-day mortality and increases ventilator-free days compared to standard care. Although the study was unblinded and faced slow enrollment, the results demonstrate a number needed to treat of fewer than seven, suggesting substantial clinical benefit for patients with ARDS secondary to pneumonia or sepsis. Notably, the intervention does not correlate with statistically significant increases in hyperglycemia or ICU-acquired infections. This trial serves as a critical precursor to broader discussions on the role of corticosteroids in managing inflammatory respiratory failure, highlighting the importance of patient phenotyping and underlying etiology in determining treatment response.