Symposium 10 - APRC 2024

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Symposium 10：Treatment Strategies for Acute Respiratory Distress Syndrome due to Coronavirus Disease 2019

Acute respiratory distress syndrome (ARDS) is a severe pulmonary disease with high mortality. Besides the traditional protective lung ventilation strategy, recent treatment modalities have shown promising results. High-flow nasal cannula is employed in early ARDS due to Coronavirus disease 2019 (COVID-19). Besides the survival benefits in moderate to severe ARDS, prone positioning has been widely applied for COVID-19 patients, either intubated or non-intubated. Extracorporeal membrane oxygenation (ECMO) has also been used largely in patients with COVID-19 with acute respiratory distress syndrome during the pandemic. This symposium will discuss and summarize the evidence and recommendations about the three aforementioned treatment modalities for ARDS, especially due to COVID-19. The speakers will also share their clinical experiences in treating ARDS patietns.

Date: Saturday, April 27, 2024 | Time: 14:50-16:20 (GMT+8)

Moderator: Prof. Chung-Chi Huang (Taiwan) | Dr. Chin-Pyng Wu (Taiwan) | Dr. Shih-Chi Ku (Taiwan)

Time (GMT+8)	Topic	Speaker	Country / Region
14:50-15:20	High-flow nasal cannula for ARDS	Dr. Li-Kuo Kuo	Taiwan
15:20-15:50	Prone Positioning for ARDS	Dr. Ming-Cheng Chan	Taiwan
15:50-16:20	Extracorporeal membrane oxygenation for ARDS	Dr. Shu-Min Lin	Taiwan

High-flow nasal cannula for ARDS

Abstract:

The use of high-flow nasal cannula (HFNC) in adult patients with acute hypoxemic respiratory failure has continuously increased especially in COVID-19 pandemic. New category of non-intubated ARDS is created for patients on HFNC at ⩾30 L/min who otherwise meet ARDS criteria in a recently published global definition of ARDS. Recent research in ARDS gradually focused on the importance of identifying clinical and biological features subphenotypes in ARDS patients. Different subphenotypes might have different outcomes and response to specific therapies including HFNC. Here we will introduce and review the most recent improvement in application of HFNC to patients with ARDS.

Dr. Li-Kuo Kuo

Chief | MacKay Memorial Hospital
Taiwan

Professional Experience:

2018-2023 Chief , Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei branch, Taiwan.

Prone Positioning for ARDS

Abstract:
Acute Respiratory Distress Syndrome (ARDS) remains a significant challenge in critical care medicine, characterized by severe hypoxemia, diffuse pulmonary inflammation, and respiratory failure. Over the years, prone positioning has emerged as a promising intervention to improve oxygenation and outcomes in patients with ARDS.

Numerous studies and clinical trials have investigated the impact of prone positioning on ARDS outcomes. Meta-analyses of these trials consistently demonstrate significant improvements in oxygenation metrics, including PaO2/FiO2 ratio and oxygenation index, in patients placed in the prone position compared to those in the supine position. Furthermore, prone positioning has been associated with a reduction in mortality rates, although the magnitude of these benefits may vary depending on patient characteristics and the timing of prone sessions.

The physiological mechanisms underlying the efficacy of prone positioning are multifactorial and include more uniform ventilation-perfusion matching, reduced lung stress and strain, improved drainage of secretions, and attenuation of ventilator-induced lung injury. Additionally, recent evidence suggests that early initiation of prone positioning within the first 48 hours of ARDS onset may confer greater benefits compared to delayed prone positioning.

Despite its benefits, prone positioning is not without limitations and potential complications, such as pressure sores, endotracheal tube displacement, and hemodynamic instability. Careful patient selection, adequate sedation and paralysis, and meticulous positioning protocols are essential to mitigate these risks and optimize the effectiveness of prone positioning.

In conclusion, prone positioning represents a valuable adjunctive therapy in the management of ARDS, offering significant improvements in oxygenation, ventilation, and mortality outcomes. Early application, adherence to lung protective strategy, and longer duration (at least 16 hours/day) are keys to the successful management of ARDS with prone positioning.

Dr. Ming-Cheng Chan

Attending Physicin | Taichung Veterans General Hospital
Taiwan

Professional Experience:

Dr. Ming-Cheng Chan is a pulmonary and critical care physician with a focus on acute respiratory failure, mechanical ventilation, and the management of acute respiratory distress syndrome. He is also the founder and leader of the Taiwan Severe Influenza Research Consortium (TSIRC), comprising eight major medical centers, dedicated to studying outcomes and risk factors in patients with severe influenza. Recently, Dr. Chan has been dedicated to leveraging artificial intelligence as a clinical decision support tool, utilizing data from the Taichung Veterans General Hospital Critical Care Database. This endeavor has been recognized with a silver prize at the Taiwan National Biotechnology and Medical Care Quality Award.

Extracorporeal membrane oxygenation for ARDS

Abstract:

Extracorporeal membrane oxygenation (ECMO) has been widely used to provide respiratory and hemodynamic support to acute respiratory distress syndrome (ARDS) patients with severe hypoxemia. Recent studies have investigated the potential survival benefits of ECMO in patients with COVID-19 related ARDS and have shown that ECMO might be beneficial in some instances. However, ECMO is an invasive treatment with various complications that requires extensive monitoring and management. Indeed, the mortality of patients with COVID-19-associated ARDS managed with ECMO may be attribute to the involvement of experienced teams to decrease the rates of complications. This presentation aims to elucidate the associations between the use of ECMO and clinical outcomes of COVID-19 patients with ARDS.

Dr. Shu-Min Lin

Attending Physician｜Chang Gung Memorial Hospital, Linkou
Taiwan

Professional Experience:

Shu-Min Lin is Professor of Medicine at the National Tsing Hua University, Taiwan. The Director of Department of Respiratory Therapy at Chang Gung Memorial Hospital, Linkuo branch, he is also a member of Taiwan Center for Disease Control Advisory Committee. His research interests include pulmonary medicine, critical care medicine, and airway disease. He began his medical career at the Taipei Medical University, and undertook medical training at the Chang Gung Memorial Hospital. From 2000 to 2002, he was Senior Fellow, Division of Pulmonary and Critical Care Medicine, University of Washington, WA, USA. He has published over 130 peer-reviewed papers on lung inflammation, TB, and critical care and has been an invited Speaker at conferences and symposia throughout the Asia-Pacific region. Dr Lin has been serving as an associate editor of Frontiers in Medicine and editorial board member of Biomedicines since 2022.

Prof. Chung-Chi Huang

Professor, Attending Physician | Chang Gung Memorial Hospital, Linkou
Taiwan

Professional Experience:

Curriculum Vitae

Office Address: 5 Fu-Shin Street, Kweishan, Taoyuan County, Taiwan
Language: Chinese, Taiwanese, English
Employment Record:
July 1986 ~ June1989, Residency in Department of Internal Medicine
July 1989 ~ June 1991, Fellowship in Division of Pulmonary Medicine
July 1991 till now, Attending Physician in Division of Pulmonary Medicine

Academic Appointment:
Aug 2001 till now, Chief, Respsiratory Therapy Department
July 2002 till now, Associate Professor, Chang Gung Memeorial Hospital
Jan 2004 till now, Associate Professor, Chang Gung University
Dec 2010 till now, Director, Department of respiratory care, Chang Gung University
August 2011 till now, Professor, Chang Gung University
July 2012 till now, Professor, Chang Gung Memeorial Hospital

Board Certification:
July 1990 Medical specialist in internal medicine, ROC
Dec 1991 Medical specialist in pulmonary and critical care medicine
Dec 1998 Specialist in Emergency and critical care medicne
Dec 1999 Specialist in critical care medicne, ROC

Professional Affiliations:
1. Society of internal medicine, ROC
2. Pulmonary and critical care medicine
3. Society of critical care medicine, ROC
4. Society of emergency and critical care medicine
5. Society of ultrasonic medicine
6. Society of family medicine, ROC

Research Interest:
1. Chest medicine
2. Critical Care Medicine

Dr. Chin-Pyng Wu

Preside | Landseed International Hospital
Taiwan

Professional Experience:

Dr. Wu Qingping received complete training in thoracic medicine at the Tri-Service General Hospital and complete training in respiratory care at the State University of New York at Stony Brook. He has served as a director and supervisor of the Society of Critical Care Medicine of the Republic of China, the Taiwan Society of Thoracic and Intensive Care Medicine, and the Society of Emergency and Intensive Care Medicine for many terms. He is a well-known expert in critical care medicine and sleep medicine in China. Many of his research and development results have been published in well-known SCI journals

Dr. Shih-Chi Ku

Director Of Medical Intensive Units | National Taiwan University Hospital
Taiwan

Professional Experience:

Dr. Shih-Chi Ku, M.D., M.P.H. is the director of the Medical Intensive Care Units and Respiratory Care Center at National Taiwan University Hospital (NTUH), Taipei, Taiwan. He has been an attending physician working on the Medical Intensive Care Unit for 20 years. His expertise is in the field of Respiratory medicine and Critical Care. As being the clinical associate professor of Department of Internal Medicine, National Taiwan University College of Medicine, his research interest includes the pulmonary infection, epidemiology of sepsis, obstructive airway disease and medical education. He works as the Deputy Director of residency training program at Department of Internal Medicine at NTUH for years. He instructs the curriculum for high-fidelity simulation in critical care residency training for years.

Symposium 10：Treatment Strategies for Acute Respiratory Distress Syndrome due to Coronavirus Disease 2019

APRC 2024 Secretariat

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