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In defence of extrapolation but not improvisation in SARS-CoV-2 lung disease

Oleg Epelbaum, Irene Galperin
Breathe 2020 16: 200113; DOI: 10.1183/20734735.0113-2020
Oleg Epelbaum
1Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
2New York Medical College, Valhalla, NY, USA
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  • For correspondence: oleg.epelbaum@wmchealth.org
Irene Galperin
3Lenox Hill Hospital Northwell Health, New York, NY, USA
4Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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    Figure 1

    Comparison between the SARS Coronaviridae and recent pandemic influenza strains with respect to three histological patterns of lung involvement derived from the aggregation of major available English language reports. The characteristic influenza pattern of DAD and/or bland diffuse alveolar haemorrhage (DAH) is nearly invariable across described cases, with bacterial pneumonia the principal finding in the remainder. All the influenza reports and all but a few of the Coronaviridae reports included in the calculation evaluated post mortem samples. Percentages for influenza H5N1 were derived from references tabulated in [18]. Percentages for influenza H1N1 were compiled from references [19–25]. SARS-CoV-1 percentages were derived from references tabulated in [26]. SARS-CoV-2 percentages were compiled from references [6, 17, 27–37]. BO: bronchiolitis obliterans.

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  • Table 1

    Summary of major RCTs in ARDS that produced contradicting results

    Study parameterInitial trialYearResultSubsequent trialYearResult
    PPProne-Supine II [40]2009No impact on survivalPROSEVA [41]2013Improved survival
    OLVLOVS [42]2008No impact on survivalART [43]2017Reduced survival
    NMBAACURASYS [44]2010Improved survivalROSE [45]2019No impact on survival
    CSNHLBI [46]2006No impact on survivalDEXA-ARDS [38]2020Improved survival

    PP: prone positioning; OLV: open-lung ventilation; NMBA: neuromuscular blocking agent; CS: corticosteroids.

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    In defence of extrapolation but not improvisation in SARS-CoV-2 lung disease
    Oleg Epelbaum, Irene Galperin
    Breathe Jun 2020, 16 (2) 200113; DOI: 10.1183/20734735.0113-2020

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    In defence of extrapolation but not improvisation in SARS-CoV-2 lung disease
    Oleg Epelbaum, Irene Galperin
    Breathe Jun 2020, 16 (2) 200113; DOI: 10.1183/20734735.0113-2020
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    • Article
      • Abstract
      • Abstract
      • Improvisation versus extrapolation
      • SARS-CoV-2 lung disease through the prism of ARDS histology
      • The problem of “lumping”
      • Pessimism about help from clinical trials
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    • Respiratory infections and tuberculosis
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