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  1. Article ; Online: Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Following Extubation on Liberation From Respiratory Support in Critically Ill Children: A Randomized Clinical Trial.

    Ramnarayan, Padmanabhan / Richards-Belle, Alvin / Drikite, Laura / Saull, Michelle / Orzechowska, Izabella / Darnell, Robert / Sadique, Zia / Lester, Julie / Morris, Kevin P / Tume, Lyvonne N / Davis, Peter J / Peters, Mark J / Feltbower, Richard G / Grieve, Richard / Thomas, Karen / Mouncey, Paul R / Harrison, David A / Rowan, Kathryn M

    JAMA

    2022  Volume 327, Issue 16, Page(s) 1555–1565

    Abstract: Importance: The optimal first-line mode of noninvasive respiratory support following extubation of critically ill children is not known.: Objective: To evaluate the noninferiority of high-flow nasal cannula (HFNC) therapy as the first-line mode of ... ...

    Abstract Importance: The optimal first-line mode of noninvasive respiratory support following extubation of critically ill children is not known.
    Objective: To evaluate the noninferiority of high-flow nasal cannula (HFNC) therapy as the first-line mode of noninvasive respiratory support following extubation, compared with continuous positive airway pressure (CPAP), on time to liberation from respiratory support.
    Design, setting, and participants: This was a pragmatic, multicenter, randomized, noninferiority trial conducted at 22 pediatric intensive care units in the United Kingdom. Six hundred children aged 0 to 15 years clinically assessed to require noninvasive respiratory support within 72 hours of extubation were recruited between August 8, 2019, and May 18, 2020, with last follow-up completed on November 22, 2020.
    Interventions: Patients were randomized 1:1 to start either HFNC at a flow rate based on patient weight (n = 299) or CPAP of 7 to 8 cm H2O (n = 301).
    Main outcomes and measures: The primary outcome was time from randomization to liberation from respiratory support, defined as the start of a 48-hour period during which the child was free from all forms of respiratory support (invasive or noninvasive), assessed against a noninferiority margin of an adjusted hazard ratio (HR) of 0.75. There were 6 secondary outcomes, including mortality at day 180 and reintubation within 48 hours.
    Results: Of the 600 children who were randomized, 553 children (HFNC, 281; CPAP, 272) were included in the primary analysis (median age, 3 months; 241 girls [44%]). HFNC failed to meet noninferiority, with a median time to liberation of 50.5 hours (95% CI, 43.0-67.9) vs 42.9 hours (95% CI, 30.5-48.2) for CPAP (adjusted HR, 0.83; 1-sided 97.5% CI, 0.70-∞). Similar results were seen across prespecified subgroups. Of the 6 prespecified secondary outcomes, 5 showed no significant difference, including the rate of reintubation within 48 hours (13.3% for HFNC vs 11.5 % for CPAP). Mortality at day 180 was significantly higher for HFNC (5.6% vs 2.4% for CPAP; adjusted odds ratio, 3.07 [95% CI, 1.1-8.8]). The most common adverse events were abdominal distension (HFNC: 8/281 [2.8%] vs CPAP: 7/272 [2.6%]) and nasal/facial trauma (HFNC: 14/281 [5.0%] vs CPAP: 15/272 [5.5%]).
    Conclusions and relevance: Among critically ill children requiring noninvasive respiratory support following extubation, HFNC compared with CPAP following extubation failed to meet the criterion for noninferiority for time to liberation from respiratory support.
    Trial registration: isrctn.org Identifier: ISRCTN60048867.
    MeSH term(s) Adolescent ; Airway Extubation ; Cannula ; Child ; Child, Preschool ; Continuous Positive Airway Pressure ; Critical Illness/therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Oxygen Inhalation Therapy/instrumentation ; Oxygen Inhalation Therapy/methods
    Language English
    Publishing date 2022-04-08
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Pragmatic Clinical Trial ; Randomized Controlled Trial
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.3367
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units: A Randomized Clinical Trial.

    Ramnarayan, Padmanabhan / Richards-Belle, Alvin / Drikite, Laura / Saull, Michelle / Orzechowska, Izabella / Darnell, Robert / Sadique, Zia / Lester, Julie / Morris, Kevin P / Tume, Lyvonne N / Davis, Peter J / Peters, Mark J / Feltbower, Richard G / Grieve, Richard / Thomas, Karen / Mouncey, Paul R / Harrison, David A / Rowan, Kathryn M

    JAMA

    2022  Volume 328, Issue 2, Page(s) 162–172

    Abstract: Importance: The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known.: Objective: To evaluate the noninferiority of high-flow nasal cannula therapy (HFNC) as the first-line mode of noninvasive respiratory ... ...

    Abstract Importance: The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known.
    Objective: To evaluate the noninferiority of high-flow nasal cannula therapy (HFNC) as the first-line mode of noninvasive respiratory support for acute illness, compared with continuous positive airway pressure (CPAP), for time to liberation from all forms of respiratory support.
    Design, setting, and participants: Pragmatic, multicenter, randomized noninferiority clinical trial conducted in 24 pediatric critical care units in the United Kingdom among 600 acutely ill children aged 0 to 15 years who were clinically assessed to require noninvasive respiratory support, recruited between August 2019 and November 2021, with last follow-up completed in March 2022.
    Interventions: Patients were randomized 1:1 to commence either HFNC at a flow rate based on patient weight (n = 301) or CPAP of 7 to 8 cm H2O (n = 299).
    Main outcomes and measures: The primary outcome was time from randomization to liberation from respiratory support, defined as the start of a 48-hour period during which a participant was free from all forms of respiratory support (invasive or noninvasive), assessed against a noninferiority margin of an adjusted hazard ratio of 0.75. Seven secondary outcomes were assessed, including mortality at critical care unit discharge, intubation within 48 hours, and use of sedation.
    Results: Of the 600 randomized children, consent was not obtained for 5 (HFNC: 1; CPAP: 4) and respiratory support was not started in 22 (HFNC: 5; CPAP: 17); 573 children (HFNC: 295; CPAP: 278) were included in the primary analysis (median age, 9 months; 226 girls [39%]). The median time to liberation in the HFNC group was 52.9 hours (95% CI, 46.0-60.9 hours) vs 47.9 hours (95% CI, 40.5-55.7 hours) in the CPAP group (absolute difference, 5.0 hours [95% CI -10.1 to 17.4 hours]; adjusted hazard ratio 1.03 [1-sided 97.5% CI, 0.86-∞]). This met the criterion for noninferiority. Of the 7 prespecified secondary outcomes, 3 were significantly lower in the HFNC group: use of sedation (27.7% vs 37%; adjusted odds ratio, 0.59 [95% CI, 0.39-0.88]); mean duration of critical care stay (5 days vs 7.4 days; adjusted mean difference, -3 days [95% CI, -5.1 to -1 days]); and mean duration of acute hospital stay (13.8 days vs 19.5 days; adjusted mean difference, -7.6 days [95% CI, -13.2 to -1.9 days]). The most common adverse event was nasal trauma (HFNC: 6/295 [2.0%]; CPAP: 18/278 [6.5%]).
    Conclusions and relevance: Among acutely ill children clinically assessed to require noninvasive respiratory support in a pediatric critical care unit, HFNC compared with CPAP met the criterion for noninferiority for time to liberation from respiratory support.
    Trial registration: ISRCTN.org Identifier: ISRCTN60048867.
    MeSH term(s) Administration, Inhalation ; Cannula ; Continuous Positive Airway Pressure/adverse effects ; Critical Care/methods ; Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Oxygen Inhalation Therapy/adverse effects ; Oxygen Inhalation Therapy/instrumentation ; Oxygen Inhalation Therapy/methods ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy
    Language English
    Publishing date 2022-06-16
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.9615
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Reduced exposure to vasopressors through permissive hypotension to reduce mortality in critically ill people aged 65 and over: the 65 RCT.

    Mouncey, Paul R / Richards-Belle, Alvin / Thomas, Karen / Harrison, David A / Sadique, M Zia / Grieve, Richard D / Camsooksai, Julie / Darnell, Robert / Gordon, Anthony C / Henry, Doreen / Hudson, Nicholas / Mason, Alexina J / Saull, Michelle / Whitman, Chris / Young, J Duncan / Lamontagne, François / Rowan, Kathryn M

    Health technology assessment (Winchester, England)

    2021  Volume 25, Issue 14, Page(s) 1–90

    Abstract: Background: Vasopressors are administered to critical care patients to avoid hypotension, which is associated with myocardial injury, kidney injury and death. However, they work by causing vasoconstriction, which may reduce blood flow and cause other ... ...

    Abstract Background: Vasopressors are administered to critical care patients to avoid hypotension, which is associated with myocardial injury, kidney injury and death. However, they work by causing vasoconstriction, which may reduce blood flow and cause other adverse effects. A mean arterial pressure target typically guides administration. An individual patient data meta-analysis (Lamontagne F, Day AG, Meade MO, Cook DJ, Guyatt GH, Hylands M,
    Objective: To estimate the clinical effectiveness and cost-effectiveness of reduced vasopressor exposure through permissive hypotension (i.e. a lower mean arterial pressure target of 60-65 mmHg) in older critically ill patients.
    Design: A pragmatic, randomised clinical trial with integrated economic evaluation.
    Setting: Sixty-five NHS adult general critical care units.
    Participants: Critically ill patients aged ≥ 65 years receiving vasopressors for vasodilatory hypotension.
    Interventions: Intervention - permissive hypotension (i.e. a mean arterial pressure target of 60-65 mmHg). Control (usual care) - a mean arterial pressure target at the treating clinician's discretion.
    Main outcome measures: The primary clinical outcome was 90-day all-cause mortality. The primary cost-effectiveness outcome was 90-day incremental net monetary benefit. Secondary outcomes included receipt and duration of advanced respiratory and renal support, mortality at critical care and acute hospital discharge, and questionnaire assessment of cognitive decline and health-related quality of life at 90 days and 1 year.
    Results: Of 2600 patients randomised, 2463 (permissive hypotension,
    Limitations: The intervention was unblinded, with risk of bias minimised through central allocation concealment and a primary outcome not subject to observer bias. The control group event rate was higher than anticipated.
    Conclusions: In critically ill patients aged ≥ 65 years receiving vasopressors for vasodilatory hypotension, permissive hypotension did not significantly reduce 90-day mortality compared with usual care. The absolute treatment effect on 90-day mortality, based on 95% confidence intervals, was between a 6.8-percentage reduction and a 1.1-percentage increase in mortality.
    Future work: Future work should (1) update the individual patient data meta-analysis, (2) explore approaches for evaluating heterogeneity of treatment effect and (3) explore 65 trial conduct, including use of deferred consent, to inform future trials.
    Trial registration: Current Controlled Trials ISRCTN10580502.
    Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in
    MeSH term(s) Adult ; Aged ; Cost-Benefit Analysis ; Critical Illness ; Humans ; Hypotension/drug therapy ; Quality of Life ; Quality-Adjusted Life Years ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2021-02-25
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
    ZDB-ID 2006765-3
    ISSN 2046-4924 ; 1366-5278
    ISSN (online) 2046-4924
    ISSN 1366-5278
    DOI 10.3310/hta25140
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial.

    Lamontagne, François / Richards-Belle, Alvin / Thomas, Karen / Harrison, David A / Sadique, M Zia / Grieve, Richard D / Camsooksai, Julie / Darnell, Robert / Gordon, Anthony C / Henry, Doreen / Hudson, Nicholas / Mason, Alexina J / Saull, Michelle / Whitman, Chris / Young, J Duncan / Rowan, Kathryn M / Mouncey, Paul R

    JAMA

    2020  Volume 323, Issue 10, Page(s) 938–949

    Abstract: Importance: Vasopressors are commonly administered to intensive care unit (ICU) patients to raise blood pressure. Balancing risks and benefits of vasopressors is a challenge, particularly in older patients.: Objective: To determine whether reducing ... ...

    Abstract Importance: Vasopressors are commonly administered to intensive care unit (ICU) patients to raise blood pressure. Balancing risks and benefits of vasopressors is a challenge, particularly in older patients.
    Objective: To determine whether reducing exposure to vasopressors through permissive hypotension (mean arterial pressure [MAP] target, 60-65 mm Hg) reduces mortality at 90 days in ICU patients aged 65 years or older with vasodilatory hypotension.
    Design, setting, and participants: A multicenter, pragmatic, randomized clinical trial was conducted in 65 ICUs in the United Kingdom and included 2600 randomized patients aged 65 years or older with vasodilatory hypotension (assessed by treating clinician). The study was conducted from July 2017 to March 2019, and follow-up was completed in August 2019.
    Interventions: Patients were randomized 1:1 to vasopressors guided either by MAP target (60-65 mm Hg, permissive hypotension) (n = 1291) or according to usual care (at the discretion of treating clinicians) (n = 1307).
    Main outcome and measures: The primary clinical outcome was all-cause mortality at 90 days.
    Results: Of 2600 randomized patients, after removal of those who declined or had withdrawn consent, 2463 (95%) were included in the analysis of the primary outcome (mean [SD] age 75 years [7 years]; 1387 [57%] men). Patients randomized to the permissive hypotension group had lower exposure to vasopressors compared with those in the usual care group (median duration 33 hours vs 38 hours; difference in medians, -5.0; 95% CI, -7.8 to -2.2 hours; total dose in norepinephrine equivalents median, 17.7 mg vs 26.4 mg; difference in medians, -8.7 mg; 95% CI, -12.8 to -4.6 mg). At 90 days, 500 of 1221 (41.0%) in the permissive hypotension compared with 544 of 1242 (43.8%) in the usual care group had died (absolute risk difference, -2.85%; 95% CI, -6.75 to 1.05; P = .15) (unadjusted relative risk, 0.93; 95% CI, 0.85-1.03). When adjusted for prespecified baseline variables, the odds ratio for 90-day mortality was 0.82 (95% CI, 0.68 to 0.98). Serious adverse events were reported for 79 patients (6.2%) in the permissive care group and 75 patients (5.8%) in the usual care group. The most common serious adverse events were acute renal failure (41 [3.2%] vs 33 [2.5%]) and supraventricular cardiac arrhythmia (12 [0.9%] vs 13 [1.0%]).
    Conclusions and relevance: Among patients 65 years or older receiving vasopressors for vasodilatory hypotension, permissive hypotension compared with usual care did not result in a statistically significant reduction in mortality at 90 days. However, the confidence interval around the point estimate for the primary outcome should be considered when interpreting the clinical importance of the study.
    Trial registration: isrctn.org Identifier: ISRCTN10580502.
    MeSH term(s) Acute Kidney Injury/etiology ; Aged ; Aged, 80 and over ; Atrial Premature Complexes/etiology ; Cognition Disorders/etiology ; Confidence Intervals ; Female ; Hospital Mortality ; Humans ; Hypotension/complications ; Hypotension/drug therapy ; Hypotension/mortality ; Intensive Care Units ; Kaplan-Meier Estimate ; Male ; Vasoconstrictor Agents/administration & dosage ; Vasoconstrictor Agents/adverse effects
    Chemical Substances Vasoconstrictor Agents
    Language English
    Publishing date 2020-02-07
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Pragmatic Clinical Trial ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.0930
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

    Angus, Derek C / Derde, Lennie / Al-Beidh, Farah / Annane, Djillali / Arabi, Yaseen / Beane, Abigail / van Bentum-Puijk, Wilma / Berry, Lindsay / Bhimani, Zahra / Bonten, Marc / Bradbury, Charlotte / Brunkhorst, Frank / Buxton, Meredith / Buzgau, Adrian / Cheng, Allen C / de Jong, Menno / Detry, Michelle / Estcourt, Lise / Fitzgerald, Mark /
    Goossens, Herman / Green, Cameron / Haniffa, Rashan / Higgins, Alisa M / Horvat, Christopher / Hullegie, Sebastiaan J / Kruger, Peter / Lamontagne, Francois / Lawler, Patrick R / Linstrum, Kelsey / Litton, Edward / Lorenzi, Elizabeth / Marshall, John / McAuley, Daniel / McGlothin, Anna / McGuinness, Shay / McVerry, Bryan / Montgomery, Stephanie / Mouncey, Paul / Murthy, Srinivas / Nichol, Alistair / Parke, Rachael / Parker, Jane / Rowan, Kathryn / Sanil, Ashish / Santos, Marlene / Saunders, Christina / Seymour, Christopher / Turner, Anne / van de Veerdonk, Frank / Venkatesh, Balasubramanian / Zarychanski, Ryan / Berry, Scott / Lewis, Roger J / McArthur, Colin / Webb, Steven A / Gordon, Anthony C / Angus, Derek / Cheng, Allen / De Jong, Menno / Gordon, Anthony / Lawler, Patrick / Webb, Steve / Campbell, Lewis / Forbes, Andrew / Gattas, David / Heritier, Stephane / Higgins, Lisa / Peake, Sandra / Presneill, Jeffrey / Seppelt, Ian / Trapani, Tony / Young, Paul / Bagshaw, Sean / Daneman, Nick / Ferguson, Niall / Misak, Cheryl / Hullegie, Sebastiaan / Pletz, Mathias / Rohde, Gernot / Rowan, Kathy / Alexander, Brian / Basile, Kim / Girard, Timothy / Huang, David / Vates, Jennifer / Beasley, Richard / Fowler, Robert / McGloughlin, Steve / Morpeth, Susan / Paterson, David / Venkatesh, Bala / Uyeki, Tim / Baillie, Kenneth / Duffy, Eamon / Fowler, Rob / Hills, Thomas / Orr, Katrina / Patanwala, Asad / Tong, Steve / Netea, Mihai / Bihari, Shilesh / Carrier, Marc / Fergusson, Dean / Goligher, Ewan / Haidar, Ghady / Hunt, Beverley / Kumar, Anand / Laffan, Mike / Lawless, Patrick / Lother, Sylvain / McCallum, Peter / Middeldopr, Saskia / McQuilten, Zoe / Neal, Matthew / Pasi, John / Schutgens, Roger / Stanworth, Simon / Turgeon, Alexis / Weissman, Alexandra / Adhikari, Neill / Anstey, Matthew / Brant, Emily / de Man, Angelique / Lamonagne, Francois / Masse, Marie-Helene / Udy, Andrew / Arnold, Donald / Begin, Phillipe / Charlewood, Richard / Chasse, Michael / Coyne, Mark / Cooper, Jamie / Daly, James / Gosbell, Iain / Harvala-Simmonds, Heli / Hills, Tom / MacLennan, Sheila / Menon, David / McDyer, John / Pridee, Nicole / Roberts, David / Shankar-Hari, Manu / Thomas, Helen / Tinmouth, Alan / Triulzi, Darrell / Walsh, Tim / Wood, Erica / Calfee, Carolyn / O’Kane, Cecilia / Shyamsundar, Murali / Sinha, Pratik / Thompson, Taylor / Young, Ian / Bihari, Shailesh / Hodgson, Carol / Laffey, John / McAuley, Danny / Orford, Neil / Neto, Ary / Lewis, Roger / McGlothlin, Anna / Miller, Eliza / Singh, Vanessa / Zammit, Claire / van Bentum Puijk, Wilma / Bouwman, Wietske / Mangindaan, Yara / Parker, Lorraine / Peters, Svenja / Rietveld, Ilse / Raymakers, Kik / Ganpat, Radhika / Brillinger, Nicole / Markgraf, Rene / Ainscough, Kate / Brickell, Kathy / Anjum, Aisha / Lane, Janis-Best / Richards-Belle, Alvin / Saull, Michelle / Wiley, Daisy / Bion, Julian / Connor, Jason / Gates, Simon / Manax, Victoria / van der Poll, Tom / Reynolds, John / van Beurden, Marloes / Effelaar, Evelien / Schotsman, Joost / Boyd, Craig / Harland, Cain / Shearer, Audrey / Wren, Jess / Clermont, Giles / Garrard, William / Kalchthaler, Kyle / King, Andrew / Ricketts, Daniel / Malakoutis, Salim / Marroquin, Oscar / Music, Edvin / Quinn, Kevin / Cate, Heidi / Pearson, Karen / Collins, Joanne / Hanson, Jane / Williams, Penny / Jackson, Shane / Asghar, Adeeba / Dyas, Sarah / Sutu, Mihaela / Murphy, Sheenagh / Williamson, Dawn / Mguni, Nhlanhla / Potter, Alison / Porter, David / Goodwin, Jayne / Rook, Clare / Harrison, Susie / Williams, Hannah / Campbell, Hilary / Lomme, Kaatje / Williamson, James / Sheffield, Jonathan / van’t Hoff, Willian / McCracken, Phobe / Young, Meredith / Board, Jasmin / Mart, Emma / Knott, Cameron / Smith, Julie / Boschert, Catherine / Affleck, Julia / Ramanan, Mahesh / D’Souza, Ramsy / Pateman, Kelsey / Shakih, Arif / Cheung, Winston / Kol, Mark / Wong, Helen / Shah, Asim / Wagh, Atul / Simpson, Joanne / Duke, Graeme / Chan, Peter / Cartner, Brittney / Hunter, Stephanie / Laver, Russell / Shrestha, Tapaswi / Regli, Adrian / Pellicano, Annamaria / McCullough, James / Tallott, Mandy / Kumar, Nikhil / Panwar, Rakshit / Brinkerhoff, Gail / Koppen, Cassandra / Cazzola, Federica / Brain, Matthew / Mineall, Sarah / Fischer, Roy / Biradar, Vishwanath / Soar, Natalie / White, Hayden / Estensen, Kristen / Morrison, Lynette / Smith, Joanne / Cooper, Melanie / Health, Monash / Shehabi, Yahya / Al-Bassam, Wisam / Hulley, Amanda / Whitehead, Christina / Lowrey, Julie / Gresha, Rebecca / Walsham, James / Meyer, Jason / Harward, Meg / Venz, Ellen / Williams, Patricia / Kurenda, Catherine / Smith, Kirsy / Smith, Margaret / Garcia, Rebecca / Barge, Deborah / Byrne, Deborah / Byrne, Kathleen / Driscoll, Alana / Fortune, Louise / Janin, Pierre / Yarad, Elizabeth / Hammond, Naomi / Bass, Frances / Ashelford, Angela / Waterson, Sharon / Wedd, Steve / McNamara, Robert / Buhr, Heidi / Coles, Jennifer / Schweikert, Sacha / Wibrow, Bradley / Rauniyar, Rashmi / Myers, Erina / Fysh, Ed / Dawda, Ashlish / Mevavala, Bhaumik / Litton, Ed / Ferrier, Janet / Nair, Priya / Buscher, Hergen / Reynolds, Claire / Santamaria, John / Barbazza, Leanne / Homes, Jennifer / Smith, Roger / Murray, Lauren / Brailsford, Jane / Forbes, Loretta / Maguire, Teena / Mariappa, Vasanth / Smith, Judith / Simpson, Scott / Maiden, Matthew / Bone, Allsion / Horton, Michelle / Salerno, Tania / Sterba, Martin / Geng, Wenli / Depuydt, Pieter / De Waele, Jan / De Bus, Liesbet / Fierens, Jan / Bracke, Stephanie / Reeve, Brenda / Dechert, William / Chassé, Michaël / Carrier, François Martin / Boumahni, Dounia / Benettaib, Fatna / Ghamraoui, Ali / Bellemare, David / Cloutier, Ève / Francoeur, Charles / Lamontagne, François / D’Aragon, Frédérick / Carbonneau, Elaine / Leblond, Julie / Vazquez-Grande, Gloria / Marten, Nicole / Wilson, Maggie / Albert, Martin / Serri, Karim / Cavayas, Alexandros / Duplaix, Mathilde / Williams, Virginie / Rochwerg, Bram / Karachi, Tim / Oczkowski, Simon / Centofanti, John / Millen, Tina / Duan, Erick / Tsang, Jennifer / Patterson, Lisa / English, Shane / Watpool, Irene / Porteous, Rebecca / Miezitis, Sydney / McIntyre, Lauralyn / Brochard, Laurent / Burns, Karen / Sandhu, Gyan / Khalid, Imrana / Binnie, Alexandra / Powell, Elizabeth / McMillan, Alexandra / Luk, Tracy / Aref, Noah / Andric, Zdravko / Cviljevic, Sabina / Đimoti, Renata / Zapalac, Marija / Mirković, Gordan / Baršić, Bruno / Kutleša, Marko / Kotarski, Viktor / Vujaklija Brajković, Ana / Babel, Jakša / Sever, Helena / Dragija, Lidija / Kušan, Ira / Vaara, Suvi / Pettilä, Leena / Heinonen, Jonna / Kuitunen, Anne / Karlsson, Sari / Vahtera, Annukka / Kiiski, Heikki / Ristimäki, Sanna / Azaiz, Amine / Charron, Cyril / Godement, Mathieu / Geri, Guillaume / Vieillard-Baron, Antoine / Pourcine, Franck / Monchi, Mehran / Luis, David / Mercier, Romain / Sagnier, Anne / Verrier, Nathalie / Caplin, Cecile / Siami, Shidasp / Aparicio, Christelle / Vautier, Sarah / Jeblaoui, Asma / Fartoukh, Muriel / Courtin, Laura / Labbe, Vincent / Leparco, Cécile / Muller, Grégoire / Nay, Mai-Anh / Kamel, Toufik / Benzekri, Dalila / Jacquier, Sophie / Mercier, Emmanuelle / Chartier, Delphine / Salmon, Charlotte / Dequin, PierreFrançois / Schneider, Francis / Morel, Guillaume / L’Hotellier, Sylvie / Badie, Julio / Berdaguer, Fernando Daniel / Malfroy, Sylvain / Mezher, Chaouki / Bourgoin, Charlotte / Megarbane, Bruno / Voicu, Sebastian / Deye, Nicolas / Malissin, Isabelle / Sutterlin, Laetitia / Guitton, Christophe / Darreau, Cédric / Landais, Mickaël / Chudeau, Nicolas / Robert, Alain / Moine, Pierre / Heming, Nicholas / Maxime, Virginie / Bossard, Isabelle / Nicholier, Tiphaine Barbarin / Colin, Gwenhael / Zinzoni, Vanessa / Maquigneau, Natacham / Finn, André / Kreß, Gabriele / Hoff, Uwe / Friedrich Hinrichs, Carl / Nee, Jens / Hagel, Stefan / Ankert, Juliane / Kolanos, Steffi / Bloos, Frank / Petros, Sirak / Pasieka, Bastian / Kunz, Kevin / Appelt, Peter / Schütze, Bianka / Kluge, Stefan / Nierhaus, Axel / Jarczak, Dominik / Roedl, Kevin / Weismann, Dirk / Frey, Anna / Klinikum Neukölln, Vivantes / Reill, Lorenz / Distler, Michael / Maselli, Astrid / Bélteczki, János / Magyar, István / Fazekas, Ágnes / Kovács, Sándor / Szőke, Viktória / Szigligeti, Gábor / Leszkoven, János / Collins, Daniel / Breen, Patrick / Frohlich, Stephen / Whelan, Ruth / McNicholas, Bairbre / Scully, Michael / Casey, Siobhan / Kernan, Maeve / Doran, Peter / O’Dywer, Michael / Smyth, Michelle / Hayes, Leanne / Hoiting, Oscar / Peters, Marco / Rengers, Els / Evers, Mirjam / Prinssen, Anton / Bosch Ziekenhuis, Jeroen / Simons, Koen / Rozendaal, Wim / Polderman, F / de Jager, P / Moviat, M / Paling, A / Salet, A / Rademaker, Emma / Peters, Anna Linda / de Jonge, E / Wigbers, J / Guilder, E / Butler, M / Cowdrey, Keri-Anne / Newby, Lynette / Chen, Yan / Simmonds, Catherine / McConnochie, Rachael / Ritzema Carter, Jay / Henderson, Seton / Van Der Heyden, Kym / Mehrtens, Jan / Williams, Tony / Kazemi, Alex / Song, Rima / Lai, Vivian / Girijadevi, Dinu / Everitt, Robert / Russell, Robert / Hacking, Danielle / Buehner, Ulrike / Williams, Erin / Browne, Troy / Grimwade, Kate / Goodson, Jennifer / Keet, Owen / Callender, Owen / Martynoga, Robert / Trask, Kara / Butler, Amelia / Schischka, Livia / Young, Chelsea / Lesona, Eden / Olatunji, Shaanti / Robertson, Yvonne / José, Nuno / Amaro dos Santos Catorze, Teodoro / de Lima Pereira, Tiago Nuno Alfaro / Neves Pessoa, Lucilia Maria / Castro Ferreira, Ricardo Manuel / Pereira Sousa Bastos, Joana Margarida / Aysel Florescu, Simin / Stanciu, Delia / Zaharia, Miahela Florentina / Kosa, Alma Gabriela / Codreanu, Daniel / Marabi, Yaseen / Al Qasim, Eman / Moneer Hagazy, Mohamned / Al Swaidan, Lolowa / Arishi, Hatim / Muñoz-Bermúdez, Rosana / Marin-Corral, Judith / Salazar Degracia, Anna / Parrilla Gómez, Francisco / Mateo López, Maria Isabel / Rodriguez Fernandez, Jorge / Cárcel Fernández, Sheila / Carmona Flores, Rosario / León López, Rafael / de la Fuente Martos, Carmen / Allan, Angela / Polgarova, Petra / Farahi, Neda / McWilliam, Stephen / Hawcutt, Daniel / Rad, Laura / O’Malley, Laura / Whitbread, Jennifer / Kelsall, Olivia / Wild, Laura / Thrush, Jessica / Wood, Hannah / Austin, Karen / Donnelly, Adrian / Kelly, Martin / O’Kane, Sinéad / McClintock, Declan / Warnock, Majella / Johnston, Paul / Gallagher, Linda Jude / Mc Goldrick, Clare / Mc Master, Moyra / Strzelecka, Anna / Jha, Rajeev / Kalogirou, Michael / Ellis, Christine / Krishnamurthy, Vinodh / Deelchand, Vashish / Silversides, Jon / McGuigan, Peter / Ward, Kathryn / O’Neill, Aisling / Finn, Stephanie / Phillips, Barbara / Mullan, Dee / Oritz-Ruiz de Gordoa, Laura / Thomas, Matthew / Sweet, Katie / Grimmer, Lisa / Johnson, Rebekah / Pinnell, Jez / Robinson, Matt / Gledhill, Lisa / Wood, Tracy / Morgan, Matt / Cole, Jade / Hill, Helen / Davies, Michelle / Antcliffe, David / Templeton, Maie / Rojo, Roceld / Coghlan, 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Elhassan, Munzir / Bakthavatsalam, Dhanalakshmi / Rowland, Matthew / Hutton, Paula / Bashyal, Archana / Davidson, Neil / Hird, Clare / Chhablani, Manish / Phalod, Gunjan / Kirkby, Amy / Archer, Simon / Netherton, Kimberley / Reschreiter, Henrik / Camsooksai, Julie / Patch, Sarah / Jenkins, Sarah / Pogson, David / Rose, Steve / Daly, Zoe / Brimfield, Lutece / Claridge, Helen / Parekh, Dhruv / Bergin, Colin / Bates, Michelle / Dasgin, Joanne / McGhee, Christopher / Sim, Malcolm / Hay, Sophie Kennedy / Henderson, Steven / Phull, Mandeep-Kaur / Zaidi, Abbas / Pogreban, Tatiana / Rosaroso, Lace Paulyn / Harvey, Daniel / Lowe, Benjamin / Meredith, Megan / Ryan, Lucy / Hormis, Anil / Walker, Rachel / Collier, Dawn / Kimpton, Sarah / Oakley, Susan / Rooney, Kevin / Rodden, Natalie / Hughes, Emma / Thomson, Nicola / McGlynn, Deborah / Walden, Andrew / Jacques, Nicola / Coles, Holly / Tilney, Emma / Vowell, Emma / Schuster-Bruce, Martin / Pitts, Sally / Miln, Rebecca / Purandare, Laura / 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    JAMA

    2020  Volume 324, Issue 13, Page(s) 1317–1329

    Abstract: Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.: Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19.: Design, setting, and participants: An ...

    Abstract Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.
    Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19.
    Design, setting, and participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020.
    Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108).
    Main outcomes and measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%).
    Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively.
    Conclusions and relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions.
    Trial registration: ClinicalTrials.gov Identifier: NCT02735707.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Adult ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/adverse effects ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/drug therapy ; Coronavirus Infections/mortality ; Coronavirus Infections/therapy ; Early Termination of Clinical Trials ; Female ; Humans ; Hydrocortisone/administration & dosage ; Hydrocortisone/adverse effects ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/mortality ; Pneumonia, Viral/therapy ; Respiration, Artificial/statistics & numerical data ; SARS-CoV-2 ; Shock/drug therapy ; Shock/etiology ; Treatment Outcome ; COVID-19 Drug Treatment
    Chemical Substances Adrenal Cortex Hormones ; Anti-Inflammatory Agents ; Hydrocortisone (WI4X0X7BPJ)
    Keywords covid19
    Language English
    Publishing date 2020-12-08
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.17022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19

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Joanne / Duke, Graeme / Chan, Peter / Cartner, Brittney / Hunter, Stephanie / Laver, Russell / Shrestha, Tapaswi / Regli, Adrian / Pellicano, Annamaria / McCullough, James / Tallott, Mandy / Kumar, Nikhil / Panwar, Rakshit / Brinkerhoff, Gail / Koppen, Cassandra / Cazzola, Federica / Brain, Matthew / Mineall, Sarah / Fischer, Roy / Biradar, Vishwanath / Soar, Natalie / White, Hayden / Estensen, Kristen / Morrison, Lynette / Smith, Joanne / Cooper, Melanie / Health, Monash / Shehabi, Yahya / Al-Bassam, Wisam / Hulley, Amanda / Whitehead, Christina / Lowrey, Julie / Gresha, Rebecca / Walsham, James / Meyer, Jason / Harward, Meg / Venz, Ellen / Williams, Patricia / Kurenda, Catherine / Smith, Kirsy / Smith, Margaret / Garcia, Rebecca / Barge, Deborah / Byrne, Deborah / Byrne, Kathleen / Driscoll, Alana / Fortune, Louise / Janin, Pierre / Yarad, Elizabeth / Hammond, Naomi / Bass, Frances / Ashelford, Angela / Waterson, Sharon / Wedd, Steve / McNamara, Robert / Buhr, Heidi / Coles, Jennifer / Schweikert, Sacha / Wibrow, Bradley / Rauniyar, Rashmi / Myers, Erina / Fysh, Ed / Dawda, Ashlish / Mevavala, Bhaumik / Litton, Ed / Ferrier, Janet / Nair, Priya / Buscher, Hergen / Reynolds, Claire / Santamaria, John / Barbazza, Leanne / Homes, Jennifer / Smith, Roger / Murray, Lauren / Brailsford, Jane / Forbes, Loretta / Maguire, Teena / Mariappa, Vasanth / Smith, Judith / Simpson, Scott / Maiden, Matthew / Bone, Allsion / Horton, Michelle / Salerno, Tania / Sterba, Martin / Geng, Wenli / Depuydt, Pieter / De Waele, Jan / De Bus, Liesbet / Fierens, Jan / Bracke, Stephanie / Reeve, Brenda / Dechert, William / Chassé, Michaël / Carrier, François Martin / Boumahni, Dounia / Benettaib, Fatna / Ghamraoui, Ali / Bellemare, David / Cloutier, Ève / Francoeur, Charles / Lamontagne, François / D’Aragon, Frédérick / Carbonneau, Elaine / Leblond, Julie / Vazquez-Grande, Gloria / Marten, Nicole / Wilson, Maggie / Albert, Martin / Serri, Karim / Cavayas, Alexandros / Duplaix, Mathilde / Williams, Virginie / Rochwerg, Bram / Karachi, Tim / Oczkowski, Simon / Centofanti, John / Millen, Tina / Duan, Erick / Tsang, Jennifer / Patterson, Lisa / English, Shane / Watpool, Irene / Porteous, Rebecca / Miezitis, Sydney / McIntyre, Lauralyn / Brochard, Laurent / Burns, Karen / Sandhu, Gyan / Khalid, Imrana / Binnie, Alexandra / Powell, Elizabeth / McMillan, Alexandra / Luk, Tracy / Aref, Noah / Andric, Zdravko / Cviljevic, Sabina / Đimoti, Renata / Zapalac, Marija / Mirković, Gordan / Baršić, Bruno / Kutleša, Marko / Kotarski, Viktor / Vujaklija Brajković, Ana / Babel, Jakša / Sever, Helena / Dragija, Lidija / Kušan, Ira / Vaara, Suvi / Pettilä, Leena / Heinonen, Jonna / Kuitunen, Anne / Karlsson, Sari / Vahtera, Annukka / Kiiski, Heikki / Ristimäki, Sanna / Azaiz, Amine / Charron, Cyril / Godement, Mathieu / Geri, Guillaume / Vieillard-Baron, Antoine / Pourcine, Franck / Monchi, Mehran / Luis, David / Mercier, Romain / Sagnier, Anne / Verrier, Nathalie / Caplin, Cecile / Siami, Shidasp / Aparicio, Christelle / Vautier, Sarah / Jeblaoui, Asma / Fartoukh, Muriel / Courtin, Laura / Labbe, Vincent / Leparco, Cécile / Muller, Grégoire / Nay, Mai-Anh / Kamel, Toufik / Benzekri, Dalila / Jacquier, Sophie / Mercier, Emmanuelle / Chartier, Delphine / Salmon, Charlotte / Dequin, PierreFrançois / Schneider, Francis / Morel, Guillaume / L’Hotellier, Sylvie / Badie, Julio / Berdaguer, Fernando Daniel / Malfroy, Sylvain / Mezher, Chaouki / Bourgoin, Charlotte / Megarbane, Bruno / Voicu, Sebastian / Deye, Nicolas / Malissin, Isabelle / Sutterlin, Laetitia / Guitton, Christophe / Darreau, Cédric / Landais, Mickaël / Chudeau, Nicolas / Robert, Alain / Moine, Pierre / Heming, Nicholas / Maxime, Virginie / Bossard, Isabelle / Nicholier, Tiphaine Barbarin / Colin, Gwenhael / Zinzoni, Vanessa / Maquigneau, Natacham / Finn, André / Kreß, Gabriele / Hoff, Uwe / Friedrich Hinrichs, Carl / Nee, Jens / Hagel, Stefan / Ankert, Juliane / Kolanos, Steffi / Bloos, Frank / Petros, Sirak / Pasieka, Bastian / Kunz, Kevin / Appelt, Peter / Schütze, Bianka / Kluge, Stefan / Nierhaus, Axel / Jarczak, Dominik / Roedl, Kevin / Weismann, Dirk / Frey, Anna / Klinikum Neukölln, Vivantes / Reill, Lorenz / Distler, Michael / Maselli, Astrid / Bélteczki, János / Magyar, István / Fazekas, Ágnes / Kovács, Sándor / Szőke, Viktória / Szigligeti, Gábor / Leszkoven, János / Collins, Daniel / Breen, Patrick / Frohlich, Stephen / Whelan, Ruth / McNicholas, Bairbre / Scully, Michael / Casey, Siobhan / Kernan, Maeve / Doran, Peter / O’Dywer, Michael / Smyth, Michelle / Hayes, Leanne / Hoiting, Oscar / Peters, Marco / Rengers, Els / Evers, Mirjam / Prinssen, Anton / Bosch Ziekenhuis, Jeroen / Simons, Koen / Rozendaal, Wim / Polderman, F / de Jager, P / Moviat, M / Paling, A / Salet, A / Rademaker, Emma / Peters, Anna Linda / de Jonge, E / Wigbers, J / Guilder, E / Butler, M / Cowdrey, Keri-Anne / Newby, Lynette / Chen, Yan / Simmonds, Catherine / McConnochie, Rachael / Ritzema Carter, Jay / Henderson, Seton / Van Der Heyden, Kym / Mehrtens, Jan / Williams, Tony / Kazemi, Alex / Song, Rima / Lai, Vivian / Girijadevi, Dinu / Everitt, Robert / Russell, Robert / Hacking, Danielle / Buehner, Ulrike / Williams, Erin / Browne, Troy / Grimwade, Kate / Goodson, Jennifer / Keet, Owen / Callender, Owen / Martynoga, Robert / Trask, Kara / Butler, Amelia / Schischka, Livia / Young, Chelsea / Lesona, Eden / Olatunji, Shaanti / Robertson, Yvonne / José, Nuno / Amaro dos Santos Catorze, Teodoro / de Lima Pereira, Tiago Nuno Alfaro / Neves Pessoa, Lucilia Maria / Castro Ferreira, Ricardo Manuel / Pereira Sousa Bastos, Joana Margarida / Aysel Florescu, Simin / Stanciu, Delia / Zaharia, Miahela Florentina / Kosa, Alma Gabriela / Codreanu, Daniel / Marabi, Yaseen / Al Qasim, Eman / Moneer Hagazy, Mohamned / Al Swaidan, Lolowa / Arishi, Hatim / Muñoz-Bermúdez, Rosana / Marin-Corral, Judith / Salazar Degracia, Anna / Parrilla Gómez, Francisco / Mateo López, Maria Isabel / Rodriguez Fernandez, Jorge / Cárcel Fernández, Sheila / Carmona Flores, Rosario / León López, Rafael / de la Fuente Martos, Carmen / Allan, Angela / Polgarova, Petra / Farahi, Neda / McWilliam, Stephen / Hawcutt, Daniel / Rad, Laura / O’Malley, Laura / Whitbread, Jennifer / Kelsall, Olivia / Wild, Laura / Thrush, Jessica / Wood, Hannah / Austin, Karen / Donnelly, Adrian / Kelly, Martin / O’Kane, Sinéad / McClintock, Declan / Warnock, Majella / Johnston, Paul / Gallagher, Linda Jude / Mc Goldrick, Clare / Mc Master, Moyra / Strzelecka, Anna / Jha, Rajeev / Kalogirou, Michael / Ellis, Christine / Krishnamurthy, Vinodh / Deelchand, Vashish / Silversides, Jon / McGuigan, Peter / Ward, Kathryn / O’Neill, Aisling / Finn, Stephanie / Phillips, Barbara / Mullan, Dee / Oritz-Ruiz de Gordoa, Laura / Thomas, Matthew / Sweet, Katie / Grimmer, Lisa / Johnson, Rebekah / Pinnell, Jez / Robinson, Matt / Gledhill, Lisa / Wood, Tracy / Morgan, Matt / Cole, Jade / Hill, Helen / Davies, Michelle / Antcliffe, David / Templeton, Maie / Rojo, Roceld / Coghlan, Phoebe / Smee, Joanna / Mackay, Euan / Cort, Jon / Whileman, Amanda / Spencer, Thomas / Spittle, Nick / Kasipandian, Vidya / Patel, Amit / Allibone, Suzanne / Genetu, Roman Mary / Ramali, Mohamed / Ghosh, Alison / Bamford, Peter / London, Emily / Cawley, Kathryn / Faulkner, Maria / Jeffrey, Helen / Smith, Tim / Brewer, Chris / Gregory, Jane / Limb, James / Cowton, Amanda / O’Brien, Julie / Nikitas, Nikitas / Wells, Colin / Lankester, Liana / Pulletz, Mark / Birch, Jenny / Wiseman, Sophie / Horton, Sarah / Alegria, Ana / Turki, Salah / Elsefi, Tarek / Crisp, Nikki / Allen, Louise / McCullagh, Iain / Robinson, Philip / Hays, Carole / Babio-Galan, Maite / Stevenson, Hannah / Khare, Divya / Pinder, Meredith / Selvamoni, Selvin / Gopinath, Amitha / Pugh, Richard / Menzies, Daniel / Mackay, Callum / Allan, Elizabeth / Davies, Gwyneth / Puxty, Kathryn / McCue, Claire / Cathcart, Susanne / Hickey, Naomi / Ireland, Jane / Yusuff, Hakeem / Isgro, Graziella / Brightling, Chris / Bourne, Michelle / Craner, Michelle / Watters, Malcolm / Prout, Rachel / Davies, Louisa / Pegler, Suzannah / Kyeremeh, Lynsey / Arbane, Gill / Wilson, Karen / Gomm, Linda / Francia, Federica / Brett, Stephen / Sousa Arias, Sonia / Elin Hall, Rebecca / Budd, Joanna / Small, Charlotte / Birch, Janine / Collins, Emma / Henning, Jeremy / Bonner, Stephen / Hugill, Keith / Cirstea, Emanuel / Wilkinson, Dean / Karlikowski, Michal / Sutherland, Helen / Wilhelmsen, Elva / Woods, Jane / North, Julie / Sundaran, Dhinesh / Hollos, Laszlo / Coburn, Susan / Walsh, Joanne / Turns, Margaret / Hopkins, Phil / Smith, John / Noble, Harriet / Depante, Maria Theresa / Clarey, Emma / Laha, Shondipon / Verlander, Mark / Williams, Alexandra / Huckle, Abby / Hall, Andrew / Cooke, Jill / Gardiner-Hill, Caroline / Maloney, Carolyn / Qureshi, Hafiz / Flint, Neil / Nicholson, Sarah / Southin, Sara / Nicholson, Andrew / Borgatta, Barbara / Turner-Bone, Ian / Reddy, Amie / Wilding, Laura / Chamara Warnapura, Loku / Agno Sathianathan, Ronan / Golden, David / Hart, Ciaran / Jones, Jo / Bannard-Smith, Jonathan / Henry, Joanne / Birchall, Katie / Pomeroy, Fiona / Quayle, Rachael / Makowski, Arystarch / Misztal, Beata / Ahmed, Iram / KyereDiabour, Thyra / Naiker, Kevin / Stewart, Richard / Mwaura, Esther / Mew, Louise / Wren, Lynn / Willams, Felicity / Innes, Richard / Doble, Patricia / Hutter, Joanne / Shovelton, Charmaine / Plumb, Benjamin / Szakmany, Tamas / Hamlyn, Vincent / Hawkins, Nancy / Lewis, Sarah / Dell, Amanda / Gopal, Shameer / Ganguly, Saibal / Smallwood, Andrew / Harris, Nichola / Metherell, Stella / Lazaro, Juan Martin / Newman, Tabitha / Fletcher, Simon / Nortje, Jurgens / Fottrell-Gould, Deirdre / Randell, Georgina / Zaman, Mohsin / Elmahi, Einas / Jones, Andrea / Hall, Kathryn / Mills, Gary / Ryalls, Kim / Bowler, Helen / Sall, Jas / Bourne, Richard / Borrill, Zoe / Duncan, Tracey / Lamb, Thomas / Shaw, Joanne / Fox, Claire / Moreno Cuesta, Jeronimo / Xavier, Kugan / Purohit, Dharam / Elhassan, Munzir / Bakthavatsalam, Dhanalakshmi / Rowland, Matthew / Hutton, Paula / Bashyal, Archana / Davidson, Neil / Hird, Clare / Chhablani, Manish / Phalod, Gunjan / Kirkby, Amy / Archer, Simon / Netherton, Kimberley / Reschreiter, Henrik / Camsooksai, Julie / Patch, Sarah / Jenkins, Sarah / Pogson, David / Rose, Steve / Daly, Zoe / Brimfield, Lutece / Claridge, Helen / Parekh, Dhruv / Bergin, Colin / Bates, Michelle / Dasgin, Joanne / McGhee, Christopher / Sim, Malcolm / Hay, Sophie Kennedy / Henderson, Steven / Phull, Mandeep-Kaur / Zaidi, Abbas / Pogreban, Tatiana / Rosaroso, Lace Paulyn / Harvey, Daniel / Lowe, Benjamin / Meredith, Megan / Ryan, Lucy / Hormis, Anil / Walker, Rachel / Collier, Dawn / Kimpton, Sarah / Oakley, Susan / Rooney, Kevin / Rodden, Natalie / Hughes, Emma / Thomson, Nicola / McGlynn, Deborah / Walden, Andrew / Jacques, Nicola / Coles, Holly / Tilney, Emma / Vowell, Emma / Schuster-Bruce, Martin / Pitts, Sally / Miln, Rebecca / Purandare, Laura / Vamplew, Luke / Spivey, Michael / Bean, Sarah / Burt, Karen / Moore, Lorraine / Day, Christopher / Gibson, Charly / Gordon, Elizabeth / Zitter, Letizia / Keenan, Samantha / Baker, Evelyn / Cherian, Shiney / Cutler, Sean / Roynon-Reed, Anna / Harrington, Kate / Raithatha, Ajay / Bauchmuller, Kris / Ahmad, Norfaizan / Grecu, Irina / Trodd, Dawn / Martin, Jane / Wrey Brown, Caroline / Arias, Ana-Marie / Craven, Thomas / Hope, David / Singleton, Jo / Clark, Sarah / Rae, Nicola / Welters, Ingeborg / Hamilton, David Oliver / Williams, Karen / Waugh, Victoria / Shaw, David / Puthucheary, Zudin / Martin, Timothy / Santos, Filipa / Uddin, Ruzena / Somerville, Alastair / Tatham, Kate Colette / Jhanji, Shaman / Black, Ethel / Dela Rosa, Arnold / Howle, Ryan / Tully, Redmond / Drummond, Andrew / Dearden, Joy / Philbin, Jennifer / Munt, Sheila / Vuylsteke, Alain / Chan, Charles / Victor, Saji / Matsa, Ramprasad / Gellamucho, Minerva / Creagh-Brown, Ben / Tooley, Joe / Montague, Laura / De Beaux, Fiona / Bullman, Laetitia / Kersiake, Ian / Demetriou, Carrie / Mitchard, Sarah / Ramos, Lidia / White, Katie / Donnison, Phil / Johns, Maggie / Casey, Ruth / Mattocks, Lehentha / Salisbury, Sarah / Dark, Paul / Claxton, Andrew / McLachlan, Danielle / Slevin, Kathryn / Lee, Stephanie / Hulme, Jonathan / Joseph, Sibet / Kinney, Fiona / Senya, Ho Jan / Oborska, Aneta / Kayani, Abdul / Hadebe, Bernard / Orath Prabakaran, Rajalakshmi / Nichols, Lesley / Thomas, Matt / Worner, Ruth / Faulkner, Beverley / Gendall, Emma / Hayes, Kati / Hamilton-Davies, Colin / Chan, Carmen / Mfuko, Celina / Abbass, Hakam / Mandadapu, Vineela / Leaver, Susannah / Forton, Daniel / Patel, Kamal / Paramasivam, Elankumaran / Powell, Matthew / Gould, Richard / Wilby, Elizabeth / Howcroft, Clare / Banach, Dorota / Fernández de Pinedo Artaraz, Ziortza / Cabreros, Leilani / White, Ian / Croft, Maria / Holland, Nicky / Pereira, Rita / Zaki, Ahmed / Johnson, David / Jackson, Matthew / Garrard, Hywel / Juhaz, Vera / Roy, Alistair / Rostron, Anthony / Woods, Lindsey / Cornell, Sarah / Pillai, Suresh / Harford, Rachel / Rees, Tabitha / Ivatt, Helen / Sundara Raman, Ajay / Davey, Miriam / Lee, Kelvin / Barber, Russell / Chablani, Manish / Brohi, Farooq / Jagannathan, Vijay / Clark, Michele / Purvis, Sarah / Wetherill, Bill / Dushianthan, Ahilanandan / Cusack, Rebecca / de Courcy-Golder, Kim / Smith, Simon / Jackson, Susan / Attwood, Ben / Parsons, Penny / Page, Valerie / Zhao, Xiao Bei / Oza, Deepali / Rhodes, Jonathan / Anderson, Tom / Morris, Sheila / Xia Le Tai, Charlotte / Thomas, Amy / Keen, Alexandra / Digby, Stephen / Cowley, Nicholas / Southern, David / Reddy, Harsha / Campbell, Andy / Watkins, Claire / Smuts, Sara / Touma, Omar / Barnes, Nicky / Alexander, Peter / Felton, Tim / Ferguson, Susan / Sellers, Katharine / Bradley-Potts, Joanne / Yates, David / Birkinshaw, Isobel / Kell, Kay / Marshall, Nicola / Carr-Knott, Lisa

    The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

    2020  

    Keywords Writing Committee for the REMAP-CAP Investigators ; Humans ; Pneumonia ; Viral ; Coronavirus Infections ; Shock ; Hydrocortisone ; Adrenal Cortex Hormones ; Anti-Inflammatory Agents ; Treatment Outcome ; Respiration ; Artificial ; Adult ; Middle Aged ; Intensive Care Units ; Female ; Male ; Early Termination of Clinical Trials ; Pandemics ; Betacoronavirus ; covid19
    Language English
    Publisher JAMA
    Publishing country uk
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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