Johns Meagan, George Stephy, Taburyanskaya Margarita, Poon Yi Kee
Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Pharmacy, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, USA.
J Pharm Pract. 2022 Aug;35(4):626-637. doi: 10.1177/0897190021998502. Epub 2021 Mar 15.
To review available evidence on corticosteroids in acute respiratory distress syndrome (ARDS), Coronavirus Disease 2019 (COVID-19), and other viral pneumonias.
A literature search of MEDLINE, PubMed and clinicaltrials.gov was performed to identify studies between 1980 to 2020 using the following search terms: corticosteroids, COVID19, severe respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and influenza. Pre-printed articles were also reviewed at medRxiv.org.
Corticosteroids were not recommended early in the COVID-19 pandemic outside of the use for concomitant indications (i.e. ARDS, septic shock) as they have been associated with delayed time to viral clearance in other viral pneumonias. A randomized trial showed a mortality benefit with dexamethasone in COVID-19. Guidelines have been updated to include a strong recommendation for their use in COVID-19 in those hospitalized requiring supplemental oxygen or mechanical ventilation.
Based on data from available randomized trials, patients that require respiratory support or mechanical ventilation benefit from corticosteroid therapy. Corticosteroids are an inexpensive and readily available therapy that should be standard of care in hospitalized COVID-19 patients requiring respiratory support.
综述关于皮质类固醇在急性呼吸窘迫综合征（ARDS）、2019冠状病毒病（COVID-19）及其他病毒性肺炎中的现有证据。
利用以下检索词对MEDLINE、PubMed和clinicaltrials.gov进行文献检索，以识别1980年至2020年间的研究：皮质类固醇、COVID-19、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、中东呼吸综合征相关冠状病毒（MERS-CoV）和流感。还在medRxiv.org上查阅了预印本文章。
在COVID-19大流行早期，除用于合并症（即ARDS、感染性休克）外，不推荐使用皮质类固醇，因为在其他病毒性肺炎中，它们与病毒清除时间延迟有关。一项随机试验显示地塞米松对COVID-19患者有降低死亡率的益处。指南已更新，强烈推荐在需要补充氧气或机械通气的住院COVID-19患者中使用皮质类固醇。
根据现有随机试验的数据，需要呼吸支持或机械通气的患者可从皮质类固醇治疗中获益。皮质类固醇是一种廉价且易于获得的治疗方法，应成为需要呼吸支持的住院COVID-19患者的标准治疗手段。
