A 40-year-old woman developed severe COVID-19 (SpO2 82%, ARDS criteria met, day 7 of illness). She requires mechanical ventilation. The RECOVERY trial's pivotal finding for this clinical stage was:
- A Dexamethasone 6 mg/day for 10 days reduced 28-day mortality in patients requiring oxygen or mechanical ventilation ✓
- B Remdesivir reduced 28-day mortality in mechanically ventilated COVID-19 ARDS patients
- C Hydroxychloroquine reduced viral load and improved survival in mechanically ventilated patients
- D Tocilizumab should be given within 24 hours of invasive ventilation as first immunomodulator regardless of CRP
Explanation
The RECOVERY trial (NEJM 2021) demonstrated that dexamethasone 6 mg once daily for up to 10 days significantly reduced 28-day mortality in hospitalised COVID-19 patients who required supplemental oxygen (NNT 8 for ventilated patients; NNT 25 for oxygen-only patients). Critically, dexamethasone was harmful in patients not requiring oxygen. Remdesivir (ACTT-1) reduced time to recovery but did not demonstrate mortality benefit in ventilated patients in SOLIDARITY and RECOVERY. Tocilizumab (as per RECOVERY/REMAP-CAP) is recommended when CRP ≥ 75 mg/L, but dexamethasone remains the foundational therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.