COVID-19-related and non-COVID-related acute respiratory distress syndrome: two sides of the same coin?
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EDITORIAL
COVID‑19‑related and non‑COVID‑related acute respiratory distress syndrome: two sides of the same coin? Audrey de Jong1,2, Oriol Roca3,4,5 and Claude Guérin6,7,8* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
In the setting of the coronavirus disease 2019 (COVID19) pandemic that has hit ICUs worldwide Ferrando et al. [1] recently published a prospective multicentre study conducted in 36 Spanish ICUs. The study focused on consecutive patients with COVID-19-related acute respiratory distress syndrome (COVID ARDS) who required invasive mechanical ventilation. Among the wealth of important and carefully recorded information provided by this study, the present editorial focuses on anticipated differences between COVID ARDS and non-COVID19-related ARDS (non-COVID ARDS), on tidal volume setting, adjunct therapies and on methodological aspects. The first, and main, controversy concerns the idea that “COVID-19 does not lead to a typical ARDS”, a hypothesis supported by the observation of 16 patients who were severely hypoxaemic but had relatively preserved respiratory system compliance (Crs) together with good lung aeration on CT scan [2]. On the basis of these findings the authors proposed avoiding high levels of positive end-expiratory pressure (PEEP) and suggested that proning may be associated with limited benefits that, in the context of the pandemic, must be balanced with the high cost of human resources. In another editorial [3], the same authors described the existence of two different phenotypes based on: elastance levels (1/Crs), pulmonary ventilation-to-perfusion ratio, lung weight, and lung recruitability. These two phenotypes, named types L and H, are characterised by low and high levels of all these variables, respectively. It has been proposed that *Correspondence: claude.guerin@chu‑lyon.fr 6 Medecine Intensive‑Réanimation, Groupement Hospitalier Lyon Centre, Hôpital Edouard-Herriot, 5 Place d’Arsonval, 69003 Lyon, France Full author information is available at the end of the article
patients with COVID-19 present early with the type L phenotype, and that some of them evolve to the type H phenotype due to COVID-19 progression and a mechanism reported to lead to patient self-inflicted lung injury [4]. Calfee et al. [5] have previously sought to phenotype non-COVID ARDS. Using the latent class analysis method, they identified a hyper-inflammatory phenotype and a low-inflammatory phenotype characterised by different responses to PEEP. The results of several studies of COVID ARDS have suggested that the respiratory mechanics and lung recruitability in these patients may be similar to those observed in non-COVID ARDS patients. In their large multicentre study, Ferrando et al. [1] attempted to corroborate this hypothesis by comparing their results with the averaged results of previous studies. No differences were observed in Crs, plateau pressure, or driving pressure. Roughly 75% of their patients received a tidal volume (VT) greater than 6 ml/kg predicted body weight (PBW), with 25% o
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