Thread by @PulmCrit

👊Martin Tobin strikes again, with a painfully incisive editorial on whether COVID-19 is ARDS. this discussion is worth having, to debunk some mis-conceptions surrounding the concept of ARDS...(1/6).
(full article: bit.ly/39NzbZB)

ARDS isn't a disease, it's a *syndrome* (an empiric grouping of abnormalities with no defined etiology). the utility of this syndrome has long been debatable. ARDS has evolved through a series of consensus definitions, which nonetheless remain profoundly flawed. (2/6)

and what if we diagnose our patient with ARDS? this has no clinical implications (other than avoiding insanely large tidal volumes). in particular, don't assume that an "ARDS" diagnosis means that the patient must be treated in some cook-book, tightly protocoled fashion (3/6)

my favorite line of the editorial: "Effect of prone positioning on ARDS mortality has been variable." 🔥🔥 proning intubated patients has been widely adopted, predominantly on the basis of a single non-blinded trial in France. Tobin seems a bit skeptical. (4/6)

"ARDS" is often used to make us feel like we know what's going on ("they have ARDS!") and that we know what to do about it ("follow the ARDS protocol!"). the inconvenient truth is that ARDS actually offers neither diagnostic nor therapeutic certainty (5/6) #TherapeuticHumility

some additional discussion of the failures of the Berlin definition of ARDS, and potential clinical approaches to parse out the heterogenious collection of patients who have ARDS (6/6):
emcrit.org/pulmcrit/pseud…

emcrit.org/pulmcrit/ards-…