About this trial
Multicenter, parallel-group, randomized clinical trial comparing the administration of systemic corticosteroids at a dose equivalent to 40 mg of prednisolone per day for 7 days vs no corticosteroid administration among adults hospitalized with severe acute respiratory infection and hypoxemia.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age ≥ 18 years.
Onset in the last 10 days AND
Results in hospitalization AND
At least one symptom or sign of respiratory illness (defined as purulent sputum, new or worsened cough, new or worsened dyspnea, tachypnea with respiratory rate ≥22 breaths per minute, rales, or bronchial breath sounds) AND
Disqualifiers
Hospitalized for >72 hours
Primary etiology of hypoxemia is a condition other than respiratory infection
Known allergy or adverse reaction to systemic corticosteroids
Known active infection with SARS-CoV-2, known active infection with Pneumocystis jirovecii, or another established indication for systemic corticosteroids
Trial design
Parallel
Treatments tested in this trial
Corticosteroid
Drugsystemic corticosteroids at a dose equivalent to 40 mg of prednisolone per day for 7 days or until discharge
Treatment groups
Trial outcomes
Primary outcomes
28-day in-hospital mortality
defined as death from any cause between randomization (Day 0) and 28 days (the end of Study Day 27. Outcome ascertainment ends at hospital discharge.
Advanced respiratory support
receipt of extracorporeal membrane oxygenation (ECMO), IMV, noninvasive mechanical ventilation, or high-flow nasal cannula (HFNC) at a rate of ≥30 liters per minute and a fraction of inspired oxygen of ≥0.4. Mechanical ventilation received solely to facilitate the performance of a procedure (e.g., mechanical ventilation for general endotracheal anesthesia limited to the performance of a surgery) will not qualify. Noninvasive mechanical ventilation received solely for the treatment of obstructive sleep apnea or obesity hypoventilation syndrome will not qualify.
Duration of advanced respiratory support
calculated as a count of calendar days, beginning with the Study Day on which the participant first received advanced respiratory support and ending with the Study Day on which the participant last received advanced respiratory support during the outcome window. Outcome ascertainment ends at hospital discharge.
Duration of hospitalization
calculated as the number of calendar days on which the participant is physically located in a short-term acute care hospital beginning at the time of randomization (Day 0) and ending with the Study Day on which the participant was discharged from the hospital during the outcome window
Sponsors and contacts
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National Institute of Allergy and Infectious Diseases (NIAID)
Lead sponsor
National Institutes of Health (NIH)
Collaborator
University of Minnesota
Collaborator
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