Thread by @teddyhla

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

@GicoBellani @ESICM What we have been looking for 50-years :
- clinical criteria based definitions
- again reference to Lorente 2015 paper on autopsy study

pubmed.ncbi.nlm.nih.gov/26385863/

Ten diseases that look like ARDS
- Guerin
pubmed.ncbi.nlm.nih.gov/25527375/

also looking at "unilateral" pneumonia not ARDS. The authors found unilteral infiltrate were intubated and some developed ARDS(i.e., become bilat),
have high Ppeak pressures.
So end up with same Lung protection

Which one is ards and which one is not

Okay forget ards. What about heart failure. The curves look the same don’t you think ?! #ventilation #ards #LIVES2022

pubmed.ncbi.nlm.nih.gov/33334944/

Tai Pham article - unilat v bilat.

Bellani proposes " get rid of ARDS label - it is too "emotional "" for intensivists.

- have acute hypoxemic respiratory failure
- categorise to mild moderate severe
- divide by aetiology
- and using latest research by Calfee use phenotypes
#ventilation #ards #LIVES2022

And cites Dr Calfee paper on phenotypes.

@threadreaderapp unroll