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Oct 24 • 10 tweets • 9 min read
@ESICM #LIVES2022 #ventilation
#ARDS #Steroids. This morning I covered "4 key questions on NIV" and "steroids". Here is a collection of those threads.
1/n
1. @DrLeoHeunks P-SILI on NIV threadreaderapp.com/thread/1584441… 2/n
@DrLeoHeunks 2. Claude Guerin on COVID vs. Non-covid NIV. threadreaderapp.com/thread/1584445…
3/n
@DrLeoHeunks 3. Giacomo GRASSELLI on Which NIV interface to use? threadreaderapp.com/thread/1584450…
4/n
@DrLeoHeunks 4. Silvia COPPOLA : PEEP selection on NIV

threadreaderapp.com/thread/1584455…

5/n
@DrLeoHeunks STEROIDS
1. @njuffermans Immunecell interactions in viral pneumonia

threadreaderapp.com/thread/1584464…

6/n
@DrLeoHeunks @njuffermans 2. Antonio Torres : Bacterial Pneumonia and Steroids

threadreaderapp.com/thread/1584470…

7/n
@DrLeoHeunks @njuffermans 3. @ElieAzoulay5 President-Elect on ARDS and Steroids

threadreaderapp.com/thread/1584475…

8/n
@DrLeoHeunks @njuffermans @ElieAzoulay5 4. Derek Angus on COVID and Steroids.
threadreaderapp.com/thread/1584480…

9/9.

#LIVES2022
#ventilation
#steroids #ards
@ESICM
@DrLeoHeunks @njuffermans @ElieAzoulay5 @ESICM @threadreaderapp unroll

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More from @teddyhla

Teddy Hla Profile picture
Oct 25
Carolyn Calfee Clinical and Biological phenotypes of ARDS
- what do they have in common?

ARDS : subgrouping since the begining
- sepsis vs. non sepsis
- hyper vs. hypoinflamm
- reactive vs uninflamed
#ventilation #ards #phenotypes #LIVES2022
Are clinical phenotypes biologically distinct?
looking at Trauma vs. Non trauma

ICAM-1 , SP-D, vWF, sTNFr-1 are different.
What about in "Direct" vs. "indirect"
or "Diffuse" vs "focal" -- sRAGE comes up again.

pubmed.ncbi.nlm.nih.gov/17944012/
#ventilation #ARDS #LIVES2022
Image
Read 13 tweets
Teddy Hla Profile picture
Oct 25
Mariangela PELLEGRINI
Uppsala- Sweden
"Do we Need a biological definition of ARDS"

- Berlin definition has NO Diffuse alveolar damage .
- the Berlin defn does not capture well
Frohlich - different definitions specificity of 0.63, 0.42, 0.31 even!
#ventilation #ards #LIVES2022
academic.oup.com/bja/article/11…
The BJA article by Frohlich.
Fibrosis only starts after 7 days
Thille article : atsjournals.org/doi/full/10.11…
In essence, different disease processes are happening to the lung at different times in the "ARDS"
pubmed.ncbi.nlm.nih.gov/24429204/
Read 14 tweets
Teddy Hla Profile picture
Oct 25
ARDS - new definition or phenotypes by @GicoBellani refreshing with Kigali definition of ARDS - useful not just low resource but during pandemic in supposedly high income settings and only draw back is no PEEp requirement #ards #ventilation #LIVES2022 @ESICM
@GicoBellani @ESICM Resolved versus confirmed ARDS
- prospectively applying Berlin definition did work but if ya wait 24 hrs and re-measure P/F ratio, you end up stratifying much better.
- Better separation of groups

pubmed.ncbi.nlm.nih.gov/29632996/
#ventilation #LIVES2022
@GicoBellani @ESICM Whichever definition - american european consensus or Berlin or Kigali -- all goes back to Ashbaugh original paper in 1967

thelancet.com/journals/lance…

Why are we so confused when it comes to ARDS definition ?

#ards #ventilation #LIVES2022 @ESICM
Read 11 tweets
Teddy Hla Profile picture
Oct 25
Next : Mypinder SEKHON on cardiac arrest in COVID-19 era.

Works in Vancouver
COVID 19 era cardiac arrest ARE a lot less sexy with all the PPE. #als #covid19 #resuscitation #LIVES2022
@ESICM
@ESICM Let's look at epidemiology. Northern Italy, Manhattan - COVID hit hard and has impact on other diseases.

e.g., OHCA in Italy during COVID 19 massive spike.
ImageImageImage
Read 9 tweets
Teddy Hla Profile picture
Oct 25
NEXT Speaker : VA ecmo for which patients?
Alain COMBES

Severe cardiogenic shock has different phenotypes
1. medical cardiogenic shock(AMI, end stage dilated CM, myocarditis, septic shock)
2. Post cardiotomy refractory CS (post CABG)
#LIVES2022
@ESICM #ecmo #resuscitation #ALS
@ESICM 2022 what do the guidelines say
- ESC recommends short term MCS should be considred in cardiogenic shock.
IABP may be considered but not routinely recommended in post MI
#LIVES2022
Image
Read 18 tweets
Teddy Hla Profile picture
Oct 25
what about in refractory cardiac arrest?
ERC - ESICM guidelines 2021
- timing of CAG if no evidence ofr ST segment evaluation.

which means we will end up treating a lot of patients with stent and anticoagulation
pubmed.ncbi.nlm.nih.gov/25800582/
TOMAHAWK trial : delayed or early invasive angiography -- no effec.

#LIVES2022
- immediate catheterisation for non ST elevationrr
Read 4 tweets

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