In Defense of Evidence-based Medicine for the Treatment of COVID-19 Acute Respiratory Distress Syndrome

Recently, the struggle against COVID-19 by respiratory and intensive care clinicians worldwide was punctuated by the sound of calls from a number of influential publications for an end to, as it were, improvisation and a return to principles of evidence-based medicine. The message was that management of SARS-CoV-2 lung disease needed to be guided strictly according to established dogma in acute respiratory distress syndrome unless supplanted by clinical trials specific to COVID-19. This position is predicated on the assumptions that knowledge about acute respiratory distress syndrome, and only about that entity, is directly translatable to SARS-CoV-2 lung disease, and that clinical trials enrolling COVID-19 patients will be completed in a sufficiently timely and rigorous fashion to influence empirical practice during the current pandemic. Clearly, there is room for an alternative perspective. In this Viewpoint, we aim to articulate a contrary point of view by resorting to arguments that are likely to resonate with frontline clinicians battling COVID-19.

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Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

Critical Care Explorations ◽

10.1097/cce.0000000000000391 ◽

2021 ◽

Vol 3 (4) ◽

pp. e0391

Author(s):

Shewit P. Giovanni ◽

Ann L. Jennerich ◽

Tessa L. Steel ◽

Sharukh Lokhandwala ◽

Waleed Alhazzani ◽

...

Keyword(s):

Systematic Review ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Evidence Based Practice ◽

Evidence Based

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Evidence-based support for prolonged glucocorticoid treatment in acute lung injury/acute respiratory distress syndrome

Critical Care Medicine ◽

10.1097/ccm.0b013e3181fa0bb1 ◽

2011 ◽

Vol 39 (1) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

G. Umberto Meduri ◽

Djillali Annane ◽

Paul E. Marik

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Evidence Based ◽

Glucocorticoid Treatment

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RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

Thorax ◽

10.1136/thoraxjnl-2021-216904 ◽

2021 ◽

pp. thoraxjnl-2021-216904

Author(s):

Mark Griffiths ◽

Susanna Meade ◽

Charlotte Summers ◽

Daniel Francis McAuley ◽

Alastair Proudfoot ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Online Survey ◽

Distress Syndrome ◽

Expert Panel ◽

Evidence Based ◽

Management Options ◽

Relevant Evidence

BackgroundCOVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from ‘classical’ ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template.MethodsAn 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1–9 (where 1–3 is inappropriate, 4–6 is uncertain and 7–9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into investigations (16), non-invasive respiratory support (18), basic intensive care unit management of ARDS (20), management of refractory hypoxaemia (8), pharmacotherapy (7) and anticoagulation (7), was completed again.ResultsDisagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For patients with ARDS with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous thromboembolic disease.ConclusionThe expert panel found no reason to deviate from the evidence-based supportive strategies for managing ARDS outlined in recent guidelines.

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Mechanical ventilation in sepsis-induced acute lung injury/acute respiratory distress syndrome: An evidence-based review

Critical Care Medicine ◽

10.1097/01.ccm.0000145947.19077.25 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. S548-S553 ◽

Cited By ~ 88

Author(s):

Jonathan E. Sevransky ◽

Mitchell M. Levy ◽

John J. Marini

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Evidence Based

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Critical Care Considerations in Adult Patients With Influenza-Induced ARDS

Critical Care Nurse ◽

10.4037/ccn2020746 ◽

2020 ◽

Vol 40 (5) ◽

pp. 15-24

Author(s):

Rachel E. Smith ◽

Megan M. Shifrin

Keyword(s):

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Medical Management ◽

Distress Syndrome ◽

Adult Patients ◽

Current Evidence ◽

Evidence Based ◽

Care Providers

Topic Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. Clinical Relevance Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. Purpose To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. Content Covered This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

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