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01-12-2020 | Acute Respiratory Distress-Syndrome | Editorial

How severe COVID-19 infection is changing ARDS management

Authors: Niall D. Ferguson, Tài Pham, Michelle Ng Gong

Published in: Intensive Care Medicine | Issue 12/2020

Excerpt

Over the last 6 months intensivists and non-intensivists around the world have been treating patients with acute respiratory distress syndrome (ARDS) brought on by COVID-19, often in extreme conditions with overwhelmed healthcare systems. As the first wave of the pandemic has passed in Europe and continues to progress in parts of North America, we pause to consider how severe COVID-19 infection is changing ARDS management and what the lasting implications might be for ARDS from other causes (Table 1).

Table 1

How severe COVID-19 is changing ARDS management

Paradigm	Example
Increased adoption of therapies previously shown to be effective in non-COVID-19 ARDS	Prone positioning in moderate-severe ARDS
Spillover adoption of therapies shown to be effective in COVID-19 ARDS	Early low-dose corticosteroids
Applying evidence-based practice, informed by bedside physiology	Increased clinical interest in respiratory mechanics
Expanding new lines of investigation that may be relevant to both COVID-19 and non-COVID-19 ARDS	Systemic anticoagulation and anti-platelet agents for pulmonary vascular thrombosis Anti-inflammatory agents Sedation with volatile anaesthetic agents Stromal cell therapies
Highlighting the existence and importance of heterogeneity of treatment effect in ARDS for many therapies	Differential effects of steroids by severity Proposals for several methods to individualize therapies (sub-phenotypes)
Socializing randomization as the norm in critical care settings	Successful implementation of RECOVERY, REMAP-CAP, ACTIV platform trials

…

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Title: How severe COVID-19 infection is changing ARDS management
Authors: Niall D. Ferguson
Tài Pham
Michelle Ng Gong
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Acute Respiratory Distress-Syndrome
COVID-19
Published in: Intensive Care Medicine / Issue 12/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06245-6

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