* pregnancy or active lactation. * patient is expected to die in the next 48 hours. * known history of dexamethasone allergy or known contraindication to the use of corticosteroids. * daily use of corticosteroids in the past 15 days. * indication for corticosteroids use for other clinical conditions (e.g. refractory septic shock). * consent refusal for participating in the trial. * different level of 4 in level 4 using the world health organization 7-point ordinal scale for clinical improvement.

* pregnancy or active lactation. * patient is expected to die in the next 48 hours. * known history of dexamethasone allergy or known contraindication to the use of corticosteroids. * daily use of corticosteroids in the past 15 days. * indication for corticosteroids use for other clinical conditions (e.g. refractory septic shock). * consent refusal for participating in the trial. * different level of 4 in level 4 using the world health organization 7-point ordinal scale for clinical improvement.

- pregnancy or active lactation. - patient is expected to die in the next 48 hours. - known history of dexamethasone allergy or known contraindication to the use of corticosteroids. - daily use of corticosteroids in the past 15 days. - indication for corticosteroids use for other clinical conditions (e.g. refractory septic shock). - consent refusal for participating in the trial. - different level of 4 in level 4 using the world health organization 7-point ordinal scale for clinical improvement.

- pregnancy or active lactation. - patient is expected to die in the next 48 hours. - known history of dexamethasone allergy or known contraindication to the use of corticosteroids. - daily use of corticosteroids in the past 15 days. - indication for corticosteroids use for other clinical conditions (e.g. refractory septic shock). - consent refusal for participating in the trial. - different level of 4 in level 4 using the world health organization 7-point ordinal scale for clinical improvement.