The Recovery Trial: Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report

The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29).  There was no benefit to patients not requiring oxygenation support and even a signal for harm.  It is important to remember this is a preprint, preliminary report, which is better than a press release. At this time, in patients requiring any oxygen therapy, HFNC, NIV, IMV, or ECMO I would recommend dexamethasone until further evidence disproves this benefit.

Bell’s Palsy…steroids! steroids! steroids!

From a recent Cochrane review, the available moderate- to high-quality evidence from randomised controlled trials showed significant benefit from treating Bell’s palsy with corticosteroids. Only 1 in 10 patients treated with corticosteroids will not recover fully (95% CI 6 to 20).


Severe croup…


  • Provide 5ml nebulized epinephrine (1:1000 concentration) and
  • Steroids (PO is the way to go. However, in severe croup, use IM, or IV if available)