Episode 15: Are You Having Trouble Breathing? ARDS or COVID-19?
Jun 30, 2020
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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Hardin C, et al. What causes hypoxemia in COVID-19? (Part 2). MGH Fast Literature Assessment and Review. 2020. Accessed 6/8/2020.
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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.
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Podcast music by Eino Toivanen, kongano.com