Episode 15: Are You Having Trouble Breathing? ARDS or COVID-19?

Episode Summary

In the first part of this episode of the APEX Live Anesthesia Podcast we’ll review the pathophysiology of ARDS and discuss the multiple theories about the pathology of COVID-19. The second part is a discussion of the management similarities and differences between ARDS and COVID-19.

 

What You'll Learn

  • What is the pathophysiologic mechanism that leads to ARDS?
  • How does COVID-19 compare to ARDS? 
  • Is it possible that COVID-19 causes ARDS? 
  • What is the most effective method for ventilating patients with ARDS and COVID-19? 
  • What are the current key management strategies of ARDS and COVID-19? 

 

Resources Discussed in this Episode

Another area where treatment may differ between ARDS and COVID-19 is the decision to give steroids. The administration of steroids for patients with ARDS are is on a case by case basis. However, there is data that now suggests that administering steroids reduces mortality in certain COVID patients.

The RECOVERY Trial – Randomized Evaluation of COVID-19 Therapy found that steroids reduced mortality in COVID patients who are intubated and on respiratory support. It included over 6000 patients with clinically suspected or laboratory confirmed COVID-19 infection. Patients received either dexamethasone 6 mg per day (PO or IV) for up to 10 days or no steroid (usual therapy). The primary outcome was 28 day all-cause mortality. They found that around 40% of intubated and ventilated patients who did NOT receive steroids died, versus a 29% mortality of intubated and ventilated patients who DID receive steroids. WOW!

There was a small trend toward harm in patients who received steroids who were not intubated or on respiratory support.

You can find out more about this research study at https://www.recoverytrial.net/

 

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Recommended Resources

  1. ARDS Definition Task Force, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012; 20;307(23): 2526–2533. 

  2. Bhatraju P, et al. Covid-19 in Critically Ill Patients in the Seattle Region – Case Series. N Engl J Med. March 2020; 382:2012-2022. 

  3. Cao, W., and Li, T. COVID-19: towards understanding of pathogenesis. Cell Res. 2020; 30(5): 367–369.

  4. Davies, J.D., et al. Should A Tidal Volume of 6 mL/kg Be Used in All Patients? Respir Care. 2016; 61(6): 774–790.

  5. Gattinoni L, et al. COVID-19 pneumonia: ARDS or not? Crit Care. April 2020; 16;24(1):154.

  6. Gattinoni L, et al. Covid-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. March 2020; 15;201(10):1299-1300. 

  7. Gattinoni L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. April 2020; 46;(6):1099-1102.

  8. Griffin, D.O., et al. Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease. Emerging Infectious Disease Journal. 2020; 29;26(8).

  9. Guérin C, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23):2159-2168.

  10. Hardin C, et al. What causes hypoxemia in COVID-19? (Part 2). MGH Fast Literature Assessment and Review. 2020. Accessed 6/8/2020.

  11. Hardin C, et al. Is COVID-19 ARDS? MGH Fast Literature Assessment and Review. 2020Accessed 6/8/2020.

  12. Klok, F.A., et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191: 145-147.

  13. Marini JJ, Gattinoni L. Management of COVID-19 Respiratory Distress. JAMA. April 2020.

  14. Mauri T, et al. Potential for Lung Recruitment and Ventilation-Perfusion Mismatch in Patients With the Acute Respiratory Distress Syndrome From Coronavirus Disease 2019. Critical Care Medicine. April 2020; 17;10:1097.

  15. Ziehr DR, et al. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study. Am J Respir Crit Care Med. Published online April 29, 2020; 15;201(12):1560-1564.

 

Legal Disclaimer

APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.

Podcast music by Eino Toivanen, kongano.com

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