Thread by @WhistlingDixie4

🫁 🧬 ARDS in Sepsis - Are biomarkers helpful? #LIVES2022

(The answer for me is - minimally…I rarely have access to them at the beside 🛌 but I presume the answer from JM Constantin has meat to it, so I’m here to listen)

We start here by asking is ARDS due to sepsis the same as that due to peritonitis or pneumonia?

And he has now changed the title to Are biomarkers helpful in ARDS?

Q1 Do we need them for diagnosis?

No- The Berlin criteria does not need them

Do we need it to improve care? (or therapeutic benefit)

In more then 50 years and millions of pounds we have great answers yet

He says we need to MOVE ON from a global syndrome to recognise the different phenotypes for ARDS

He motions this

pubmed.ncbi.nlm.nih.gov/24853585/

Which introduced two sub phenotypes…hyper inflammatory and not

If we are not recognising and balancing these in trials we will never get the results….Their relative mortality and response to treatment are not the same

ncbi.nlm.nih.gov/pmc/articles/P…

We are here at this paper now but I’ve had to get up to ask them to close the door because the talking outside is too noisy

ncbi.nlm.nih.gov/pmc/articles/P…

We’re hearing about Simvastatin and that if pro-inflammatory ARDS you can improve mortality (but not the other type)

..and that B2 against only work with certain levels of sRAGE present

(So I think the point being made her is they could be useful because they could allows to stop the merry go round of testing treatment in a group of patients defined by a syndrome that isn’t a single disease)

And he said if sRAGE for example is not available at the beside we will keep wasting opportunity.

(He doesn’t say waste, but it’s inferred - I think)

The conclusion is that biomarkers CAN help us …but we need to split according to mechanisms

And result from that might be dramatic.

So I look forward to the drama! #LIVES2022

I’ve been reminded we’re being measured up for a @PhindStudy machine so maybe the drama will come sooner than I think. #LIVES2022