Comparing and contrasting ATS and ESICM ARDS guidelines, exploring CPAP and high flow interventions, discussing corticosteroid and ECMO use, debating neuromuscular blockade benefits, controversy over recruitment maneuvers and high PEEP in critical care management
48:04
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Quick takeaways
Corticosteroids are conditionally recommended for ARDS patients by ATS guidelines based on moderate evidence, showing benefits in ventilator time reduction and mortality decrease.
ECMO use in severe ARDS varies between ATS and ESICM guidelines, with ATS recommending VV ECMO for select severe patients and ESICM favoring ECMO based on eligibility criteria from the EOLIA trial.
Differing views on neuromuscular blockade usage in early severe ARDS exist, with ATS suggesting its use with low to moderate certainty and ESICM recommending against routine continuous blockade for moderate to severe ARDS patients.
Deep dives
Steroids in ARDS
The podcast explores the use of corticosteroids in patients with ARDS. ATS guidelines suggest using corticosteroids for ARDS patients with a conditional recommendation based on moderate evidence. This recommendation stems from trials showing benefits in terms of ventilator time reduction and mortality decrease. However, concerns about hyperglycemia and other side effects are also acknowledged.
ECMO Usage
The podcast discusses the use of ECMO in severe ARDS cases. The ATS guidelines recommend VV ECMO for select severe ARDS patients with a conditional recommendation and low certainty of evidence. Contrastingly, the ESICM guidelines strongly recommend ECMO for severe ARDS patients based on the eligibility criteria used in the EOLIA trial, emphasizing the need for experienced ECMO centers.
Neuromuscular Blockade
An analysis of neuromuscular blockade usage in early severe ARDS is presented. ATS guidelines suggest neuromuscular blockade for such patients with a conditional recommendation and low to moderate certainty. In comparison, ESICM recommends against routine use of continuous neuromuscular blockade for moderate to severe ARDS patients, highlighting differing perspectives on this intervention.
Peep and Recruitment Maneuvers
Peep and recruitment maneuver recommendations are explored in the podcast. The ATS guidelines suggest using high peep without recruitment maneuvers in moderate to severe ARDS patients, alongside a critical view on prolonged recruitment maneuvers. In contrast, the ESICM guidelines refrain from providing a specific recommendation on peep and recruitment maneuvers, showcasing an area where opinions diverge.
Navigating ARDS Treatment Strategies
The episode delves into the complexities of ARDS treatment strategies based on ATS and ESICM guidelines. Discussions revolve around the nuanced decision-making required for interventions like steroids, ECMO, neuromuscular blockade, peep levels, and recruitment maneuvers in the management of ARDS patients, highlighting the balancing act between potential benefits and associated risks in critical care settings.
Episode 29! We stray a little bit from our new and old article structure to talk about two recently published but slightly different ARDS recommendations from ATS and ESCIM. We compare and contrast them and give our takes on the data and evidence.
Thanks to everyone who emails in and gives feedback, we will do our mail bag next episode!
If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
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