Thread by @teddyhla

Next: Derek Angus : motivation to "TEST" steroids in COVID-19 ARDS.
Doctors "love" giving steroids. How about we "test" it?
#LIVES2022
#ventilation
#ards #steroids @ESICM

@ESICM steroids : long list of side effects ( 2' bac infection, impair host response, impair viral clearance).
- which steroid, when, what dose, how long
- unclear if all COVID patients in hospital should receive Steroids.
#LIVES2022
#steroids #ards

@ESICM large RCTs 1. RECOVERY(UK) - not 20mg in DEXA-ARDS but 6mg. in the O2 receiving group, Dexa seems to be better. Ventilated patient - very strong signal too of dexamethasone being better.
#COVID19 #steroids #LIVES2022 @ESICM

@ESICM By the way - Derek is applauding the speed of science -- when COVID reaches N america - and starting to see trickle of patients in USA, RECOVERY is not only completed but also published and a big study too ! 😍

@ESICM Hydrocortisone and all critically ill (CAPE COVID trial)-French trial - not significant but point estimate is in favour of covid. but here good finding on cumulative additional nfections.
CODEX trial - odd that the curves are coming back together at the end but overall benefit.

Sept 2nd 2020 , BMJ and JAMA joint publication of WHO REACT. Again highlighting the speed of research and science. Signal in "sicker" COVID patients, no obvious difference by choice of steroid. NOTE : less sick pts no benefit in RECOVERY.

Despite these, ponder "residual uncertainties". 1.How were steroids actually working? 2.Was the dose correct? 3.Who should and shouldnt get? 4.What about other immunomodulation? #LIVES2022
#ventilation
#steroids #COVID19 #ards

Answer to "how steroids work" = no easy answer from RCT.
Ans to who should receive = low appetite as difficult to recruit "borderline " risk patients
Ans "dose" = current dosing beneficial "ON AVERAGE"
Ans "other Rx" - platform trial like REMAP CAP format allow comparison.

Other additional Uncertainties: Is COVID still the same? Ans: no because of immunogenicity from ancestrail variant. Then does steroids work just as well to current COVID.
ARDS pathology from current COVID-19 may or may not be the same.

FINAL Question: What happens 2 to 3 years from now with SARS-CoV3? Will we use steroids or Test steroids?
Answer : i think we will use steroids but we should "TEST" steroids first.
IF ANOTHER RESP PANDEMIC, using steroids from get-go may not be the right way forward. #LIVES2022

Lack of mechanistic understanding really compromises ability to extrapolate the findings to other ARDS or to next pandemic. We have currently time until the next pandmeic to look at this ! what a great talk :) thank you. @ESICM #steroids #LIVES2022
#COVID19

@ESICM @threadreaderapp unroll