October 11, 2021

An article review from the ESICM Journal Review Club


The rapidity at which the understanding and knowledge of COVID-19 have progressed after the outbreak of the COVID-19 pandemic was unprecedented and has surpassed many other diseases, including other severe respiratory viral infections (RVIs). One of the reasons for this progression is related to the collaborative pragmatic international multicentre adaptive trials, e.g. RECOVERY, REMAP CAP. These trials could address multiple questions at the same time. In this paper by Arabi et al., the authors focused on selected experiences gained from COVID-19 and their future relevance for other RVIs.

The authors emphasise the importance of performing well-designed randomised controlled trials. Several therapies in RVIs are largely based on observational data but are not backed up by RCTs or by appropriately powered and conducted RCTs, e.g. the use of neuraminidase inhibitors for influenza or the harm for corticosteroids in influenza.

During this ongoing COVID-19 pandemic, a better understanding was gained of the role of immune modulation and the pathogenesis of thrombotic complications due to endotheliitis. If immune modulation is effective in other RVIs and whether there is a role in the pathogenesis of microthrombi in other RVIs needs to be investigated. Also, supportive evidence for the various forms, timing and strategy of respiratory support is limited in other RVIs.

Novel study designs are likely to find their way into clinical research other than COVID-19. They will lead to more efficient answers but also carry additional design complexity and have specific limitations.


This paper gives insight into the reason for the speed of progress in knowledge made during the ongoing COVID-19 pandemic. However, this paper does not deal with substantive insights and evidence for treatments for other RVIs but highlights the lack of evidence in current strategies and unanswered questions.


New trial designs implemented during COVID-19 could address important questions to be elucidated in RVIs.


This article review was prepared and submitted by Anna Hall (Severe respiratory and ECMO fellow Guy’s & St. Thomas’ NHS Foundation Trust).


Arabi, Y.M., Derde, L.P.G. & Timsit, JF. How COVID-19 will change the management of other respiratory viral infections. Intensive Care Med 47, 1148–1151 (2021).

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