COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

Brault, C.; Zerbib, Yoann; Kontar, Loay; Fouquet, Ugo; Carpentier, Mathieu; Metzelard, Matthieu; Soupison, Thierry; Cagny, B de; Maizel, Julien; Slama, Michel

doi:10.1164/rccm.202005-2025le

Cited by 56 publications

(66 citation statements)

References 10 publications

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“…85 137 140 141 Following the preliminary retrospective analysis of respiratory physiology during IMV, 76 several larger prospective studies comparing consecutive typical ARDS and CARDS patients have been published. [143][144][145][146] These studies essentially confirm the notion of similar respiratory mechanics and physiology between the two conditions; however with some interesting nuances. One study 144 matched 30 CARDS patients with 30 typical ARDS patients based on oxygenation parameters, tidal volume, and PEEP.…”

Section: Non-invasive Ventilationsupporting

confidence: 71%

“…Compared with observations in the LUNG SAFE study, IMV duration in CARDS case series may be slightly longer85137138140 with higher rates of NMB use and prone positioning 85137140141. Following the preliminary retrospective analysis of respiratory physiology during IMV,76 several larger prospective studies comparing consecutive typical ARDS and CARDS patients have been published 143144145146. These studies essentially confirm the notion of similar respiratory mechanics and physiology between the two conditions; however with some interesting nuances.…”

Section: Respiratory Care For Severe Covid-19 Pneumoniamentioning

confidence: 66%

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Severe covid-19 pneumonia: pathogenesis and clinical management

Attaway

Scheraga

Bhimraj

et al. 2021

BMJ

325

248

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Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.

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Section: Non-invasive Ventilationsupporting

confidence: 71%

Section: Respiratory Care For Severe Covid-19 Pneumoniamentioning

confidence: 66%

Severe covid-19 pneumonia: pathogenesis and clinical management

Attaway

Scheraga

Bhimraj

et al. 2021

BMJ

325

248

View full text Add to dashboard Cite

show abstract

“…A significant decrease in Ang-2 levels was observed and attributed to reduced inflammation [61] . Another randomized, placebo-controlled, Phase 2a study ‘MultiStem’ evaluated the safety and efficacy of adult BM-MSCs and reported that the MSC treatment was associated with higher number of ventilator-free day score, better Quality of Life outcomes and more importantly, reduced levels of IL-6, IL-1β and IFN-γ 7 days post transplantation [57] .…”

Section: Msc Therapy For Ards and Ali: Lessons From The Pastmentioning

confidence: 99%

Mesenchymal stromal cell therapy for coronavirus disease 2019: which? when? and how much?

Shahani

2021

Cytotherapy

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Mesenchymal Stromal Cells (MSCs) are under active consideration as a treatment strategy to control the hyperinflammation and slow disease progression in COVID-19. The possible mechanism of protection through their immunoregulatory and paracrine action has been reviewed extensively. However, the importance of process control to achieve a consistent cell quality, maximum safety and efficacy - for which the three key questions are of ‘which’, ‘when’ and ‘how much’ - remain unaddressed. Any commonality, if exists, in the ongoing clinical trials is yet to be analysed and reviewed. In this review, we have therefore compiled and discussed study design data from ongoing clinical trials to address the key questions of ‘which’ tissue source, donor profile, isolation technique, culture conditions, long-term culture and cryopreservation for MSCs; the question of ‘when’ with regard to defining the transplantation window, by identifying and staging of patients based on their pro-inflammatory profile; and finally that of ‘how much’ with respect to the number of cells in a single administration, the number of doses and route of transplantation. To homogenize MSC therapy for COVID-19 on a global scale and to make it readily available in large numbers, a shared understanding and uniform agreement on these fundamental issues is essential.

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“…Twenty-four reviewed studies provided initial ventilator data (Table 3). 84,107,108,111,114,116,117,121,128,[141][142][143][144][145][146][147][148][149][150][151][152][153][154] In 22 of these mean/median PEEP requirements were 10-16 cmH 2 O (Table 3, Fig 1). A crude approach for determining the need for particularly high PEEP levels (ie, approaching the "super-PEEP" threshold of 20 cmH 2 O) are values demarcating 1 standard deviation (SD) above the mean, or the 75 th percentile.…”

Section: Peep and Tidal Volume Parametersmentioning

confidence: 99%

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

Kallet

2021

Respir Care

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Corona virus disease 2019 represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic respiratory failure it caused did not appear to fit conveniently or consistently into our classification of acute respiratory distress syndrome (ARDS). This not only reignited a half-century's long simmering debate over taxonomy, but also fueled similar debates over how PEEP and lung-protective ventilation should be titrated, as well as the appropriate role of non-invasive ventilation in ARDS. Furthermore, COVID-19 ignited other debates on emerging concepts such as ARDS phenotypes and patient self-inflicted lung injury from vigorous spontaneous breathing. Over a year later these early perplexities have receded into the background without having been reviewed or resolved.With a full year of evidence having been published this narrative review systematically analyzes whether or not COVID-19 associated respiratory failure is essentially ARDS, with perhaps a somewhat different course of presentation. This includes a review of the severity of hypoxemia and derangements in pulmonary mechanics, PEEP requirements, recruitment potential, the ability to achieve lung-protective ventilation goals, duration of mechanical ventilation, associated mortality, and response to non-invasive ventilation. It also reviews the concepts of ARDS phenotypes and patient self-inflicted lung injury as these are crucial to understanding the contentious debate over the nature and management of COVID-19.

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COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

Cited by 56 publications

References 10 publications

Severe covid-19 pneumonia: pathogenesis and clinical management

Severe covid-19 pneumonia: pathogenesis and clinical management

Mesenchymal stromal cell therapy for coronavirus disease 2019: which? when? and how much?

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

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