Thread by @teddyhla

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/

For example potential groups

Single Biomarkers
- Meduri looked at cytokines
- patients with higher TNF-a, IL1b,IL6,IL8 on day 1 of ARDS died more.
pubmed.ncbi.nlm.nih.gov/7587434/
#ventilation #biomarker #ards #LIVES2022

How about looking at Biomarkers for specific injury mechanisms ?
- RAGE :marker of alveolar type 1 injury
pubmed.ncbi.nlm.nih.gov/24156650/

Five best pefroming biomaekres
SP - D , RAGE (i missed the other 3)
#ventilation #ards #biomarker #LIVES2022

How about panel of biomarkers?
pubmed.ncbi.nlm.nih.gov/28450529/

good correlate with outcome
IL6
IFN gamma
Angiopoietin 2
plasminogen activator inibitor 1

better than APACHE , age , lactate, albumin, bicarb

Looking at single centre vs. multi centre

Epithelial injury including RAGE and vWF

pubmed.ncbi.nlm.nih.gov/26033126/
Now in COVID
angiopoietin
atsjournals.org/doi/10.1164/rc…
see image

So, Do we need a biological definition of ARDS?

Ans : NO
- true biological defn ARDS is out of reach
- limited mechanistic understanding of ARDS
- limited plasma biomarkers
- more markers may help
- not associated with Rx response.
- sampling huge variation.

So what can we do ?
BEST ANS : is to basically do stratification and sub-grouping for now.

Laurent Brochard : i dont think you can differentiate ARDS from Ventilator induced lung injury.

#ards #ventilation #biomarker #LIVES2022

panel john laffey : exhumed bodies in spanish flu has Diffuse alveolar damage in their lungs (this is before invention of ventilator!)

This is fascinating!!
i found this paper!
pnas.org/doi/10.1073/pn…

#ards before #ventilation @Jopo_dr thought ya might like this! :P

@Jopo_dr @threadreaderapp unroll