At present there is limited evidence for mortality benefit with steroids in ARDS despite multiple studies into this. However, the RECOVERY trial (2020) demonstrated a mortality benefit with dexamethasone in patients with COVID-19 pneumonitis requiring either mechanical invasive ventilation or oxygen alone.
After being proned for 18 hours, the patient has not responded to conventional treatment. His PaO2 is 7.7kPa on FiO2 1.0. He is fully sedated, paralysed with appropriate fluid balance. His ventilator settings have been maximally titrated. A referral for ECMO is made.
