Model Aims to Guide Physicians in Best Course of Treatment for COVID-19-Related ARDS
John J Marini, MD, a professor in the University of Minnesota Medical School’s Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and Luciano Gattinoni, MD, a professor at the University of Gottingen, Germany in the Department of Anesthesiology, have co-authored “Management of COVID-19 Respiratory Distress,” which was published in JAMA Insights, April 24, 2020.
The article compares the ways in which the COVID-19 disease presents and progresses to acute respiratory distress syndrome (ARDS) and the outcomes that are occurring when physicians treat COVID-19 with the ventilator strategies and therapeutics recommended for typical ARDS.
Although COVID-19 presents in a similar way to ARDS, with profound hypoxemia, the early and rather selective involvement of the vascular system appears to warrant a different treatment approach than is usual for routine ARDS. Taking into consideration the variable mortality rates of similar patients in the ICU suggests ventilator management may be contributing to outcomes. Overall, Drs. Marini and Gattinoni propose that without specific management of the vasocentric features of COVID-19, patients with ARDS as a result of COVID (CARDS), are more likely to progress to suffer multiple organ failure.
While patients with CARDS initially respond to standard ventilating treatments, and many will stabilize as a result of intervention, some of the more severe and advanced patients suffer progressive lung function deterioration.
“We are hearing frustration and fear from our colleagues around the world at the unusual course of the COVID-19 and the variance of outcomes they are seeing in their patients,” Dr. Marini said. “The protocols we have developed over the last 20 years are not working the way we expect them to—in fact, they rather often seem to be making some patients worse. CARDS has a unique cause and changeable physiology. The model we have developed is intended to help understanding and guide physicians in the phases of treatment to achieve the best outcomes.”
The article includes the model that provides a timeline of disease progression and describes the corresponding objectives, respiratory support options and rationale. Also included is a flow chart which maps the “VILI Vortex” and the courses of treatment indicated.