Thread by @teddyhla

Earlier we learnt the *nuances* of NIV. Next session: Steroids in ARDS. chaired by Annane Djillali and Chiche Jean-Daniel #LIVES2022
#ventilation
@ESICM

@ESICM 1. @njuffermans on immune cell interactions in viral pneumonia. Reminder : Innate and Adaptive immunity. big topic so will be a brief overview. Innate Im : goal to illicit cytokine response Granulocytes, macrophages, dendritic cells. Adaptive: T cells CD4 and CD8. #LIVES2022

@ESICM @njuffermans What happens during viral pneumonia ?
- virus causes destruction of natural barriers
- Virus then meets innate immunity "cytokine storm". made popular durn COVID19 but This term is 1st coined in 2005 with H1N1 infection.

This is not unique to COVID. See here.

COVID and non COVID infection causes "massive cytokine responses" - quantifying the cytokines - very comparable. cOVID induces complement activation outside the cell and also within inside cell too. EFFECT IS NETS (neutophil activation NETosis). #LIVES2022
#ventilation
#steroids

HIGH Interferon gamma levels in severe influenza. But in COVID non Th2/Th1 level imbalance. No antibody response in COVID is associated with adverse outcome and dysregulated NETosis. THIS IS IMPORTANT FOR CLINICIANS. #LIVES2022
#steroids #covid19nfld @ESICM

Steroids suppress many immune processes - less T cells, less IFN gamma in adaptive immunity. Less apopotiss, Less dendritic recognition in innate immunity. Same for B cells reduce Ig levels. Therefore, looking at immunomodulating in COVID patients.

steroids also have risk factors for herpes reactivation in COVID. summary : severe viral pneumonia associated with very strong immune response. Lymphoid response may become exhausted. lack of antibody response is detrimental. immune modulation is area of interest! #LIVES2022

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