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Erschienen in:
18.09.2020 | COVID-19 | Editorial
How severe COVID-19 infection is changing ARDS management
Erschienen in: Intensive Care Medicine | Ausgabe 12/2020
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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
|