Thread by @teddyhla

NEXT: Clinical question : ARDS and steroids-sensitive patterns by President-Elect @ElieAzoulay5
lots of questions: why? how ? phenotypes? timing? dose? are we missing "systemic vasculitis,etc" behind defn ARDS?
#LIVES2022
#ventilation
#steroids #ARDS @ESICM

@ElieAzoulay5 @ESICM Refreshing ARDS definition. Berlin definition needs further updates (more on this later). 🤓
Pathological : DAD : Diffuse Alveolar Damage" has many causes - most of them we wont discuss steroid use at all.

@ElieAzoulay5 @ESICM thus DAD pathological diagnosis is not helpful to ask clinical question of steroids.
Interesting finding in autopsy data in ARDS. #LIVES2022

1 year after ARDS - there are still changes in the lung but very few have "fibrosis" -- so fibrosis is EITHER completely reversible OR fibrosis patients dont survive to 1-year. We need to look at bio-markers in time-course of ARDS. #LIVES2022
#ventilation
#ards
#steroids @ESICM

in ARDS: want to reduce endothelial permeability, cytokine over-activation, neutrophil activity. Citing another classic DEXA-ARDS trial for established ARDS : 139 patients and DSMB stopped trial due to low recruitment. But data is interesting #LIVES2022
#ventilation
#steroids

in-depth on DEXA-ARDS. Open label with composite outcome (vent free day), 250 patients excluded because on steroids already. standard of care changed NMBA use 8.6% in dexa vs. 5.1% in control. 🧐🧐

summary, according to @ElieAzoulay5 not a routine use. Discussion regarding "phenotypes" & "endotypes". but Literature not conclusive. Limited data & low level of confidence. "enrichment" of trial recruitments m. #LIVES2022

@threadreaderapp unroll