key: cord-0770786-a6coc4cp
authors: Drohan, Callie; Bain, William; Kitsios, Georgios D.
title: Reply: Understanding COVID-19 Acute Respiratory Distress Syndrome: New Pathogen, Same Heterogeneous Syndrome
date: 2022-01-01
journal: Ann. Am. Thorac. Soc. (Online)
DOI: 10.1513/annalsats.202106-650le
sha: b337801035ce5ab01b841af640067303b8e8e6dc
doc_id: 770786
cord_uid: a6coc4cp

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group etiology, providing previously unrecognized pathophysiologic insights, such as the differential levels of interleukin-6 by ARDS subgroup. We recognize that our cohort's small sample size limits the statistical power to detect significant differences in VR, if truly present. However, by contextualizing our results with the available comparative reports (3, 4) and historical estimates of non-COVID-19 ARDS VRs (5), COVID-19 is more similar than dissimilar to non-COVID-19 ARDS in terms of dead-space ventilation.

Therefore, it appears that accumulating clinical data do not support intriguing theories on a distinctive COVID-19 ARDS physiology. Whereas the role of the vasculature and microthrombosis in patients with COVID-19 is being investigated, it is plausible that such mechanisms, which remain to be identified, influence the clinical course of subsets of patients. During the COVID-19 pandemic, we have gained enhanced appreciation of how heterogeneous a clinical syndrome can be, even when millions of patients are sickened by the same pathogen. We concur with Singh and colleagues that further progress in the field will require an improved understanding of ARDS heterogeneity as well as careful identification of biological endotypes and physiologic phenotypes, including when caused by COVID-19, to foster personalized medicine approaches for better patient outcomes.

COVID-19 versus non-COVID-19 ARDS: comparison of demographics, physiologic parameters, inflammatory biomarkers and clinical outcomes

Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

Comparing clinical features and outcomes in mechanically ventilated patients with COVID-19 and acute respiratory distress syndrome

COVID-19-versus non-COVID-19-related acute respiratory distress syndrome: differences and similarities

Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome