Back to the Future: A Case of Severe ARDS Responsive to Shunned Therapies, A Review of the Past, and a Road Map to Future Investigations

The COVID-19 pandemic served as a reminder of the limited treatments available for acute respiratory distress syndrome (ARDS). The pandemic has highlighted the need to identify different clinical phenotypes of ARDS and investigate various interventions and treatments, both new and old. We present a patient with severe ARDS secondary to COVID-19 who rapidly deteriorated despite neuromuscular blockade and prone ventilation. He was aggressively managed using a combination of high frequency oscillatory ventilation (HFOV), high dose methylprednisolone, TPE, and direct instillation of liquid surfactant. He had an excellent clinical response and ultimately discharged to inpatient rehabilitation, then home, totally independent. Relatively few effective treatment options exist for ARDS. Our patient’s response to a combination of interventions that have fallen out of clinical practice serves as a reminder that research is needed to help identify distinct phenotypes so that clinical trials can be designed to investigate interventions and treatments specific to the different phenotypes.