The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients.

Autor: Torres A; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain. atorres@clinic.cat.; Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. atorres@clinic.cat.; Servei de Pneumologia i Al·lèrgia Respiratòria, Hospital Clínic, Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. atorres@clinic.cat., Motos A; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain., Riera J; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain., Fernández-Barat L; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain., Ceccato A; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain., Pérez-Arnal R; Barcelona Supercomputing Center (BSC), Barcelona, Spain., García-Gasulla D; Barcelona Supercomputing Center (BSC), Barcelona, Spain., Peñuelas O; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain., Lorente JA; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain., Rodriguez A; Critical Care Department, Hospital Joan XXIII, Tarragona, Spain., de Gonzalo-Calvo D; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain., Almansa R; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.; Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia Regional de Salud de Castilla y León, Salamanca, Spain., Gabarrús A; Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain., Menéndez R; Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain., Bermejo-Martin JF; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.; Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia Regional de Salud de Castilla y León, Salamanca, Spain., Ferrer R; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain., Amaya Villar R; Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Sevilla, Spain., Añón JM; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain., Barberà C; Hospital Santa Maria, IRBLleida, Lleida, Spain., Barberán J; Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain., Blandino Ortiz A; Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain., Bustamante-Munguira E; Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain., Caballero J; Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain., Carbajales C; Hospital Álvaro Cunqueiro, Vigo, Spain., Carbonell N; Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain., Catalán-González M; Department of Intensive Care Medicine, Hospital Universitario, 12 de Octubre, Madrid, Spain., Galbán C; Department of Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain., Gumucio-Sanguino VD; Department of Intensive Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain., de la Torre MDC; Hospital de Mataró de Barcelona, Barcelona, Spain., Díaz E; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.; Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain., Estella Á; Departamento Medicina Facultad Medicina, Universidad de Cádiz, Hospital Universitario de Jerez, Jerez de la Frontera, Spain., Gallego E; Unidad de Cuidados Intensivos, Hospital San Pedro de Alcántara, Cáceres, Spain., García Garmendia JL; Intensive Care Unit, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain., Garnacho-Montero J; Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain., Gómez JM; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Huerta A; Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain., Jorge García RN; Intensive Care Department, Hospital Nuestra Señora de Gracia, Zaragoza, Spain., Loza-Vázquez A; Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Sevilla, Spain., Marin-Corral J; Critical Care Department, Hospital del Mar-IMIM, Barcelona, Spain., Martínez de la Gándara A; Department of Intensive Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain., Martínez Varela I; Critical Care Department, Hospital Universitario Lucus Augusti, Lugo, Spain., López Messa J; Complejo Asistencial Universitario de Palencia, Palencia, Spain., M Albaiceta G; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain.; Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Spain., Novo MA; Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain., Peñasco Y; Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Pozo-Laderas JC; UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain., Ricart P; Servei de medicina intensiva, Hospital Universitari Germans Trias, Badalona, Spain., Salvador-Adell I; Hospital Verge de La Cinta, Tortosa, Tarragona, Spain., Sánchez-Miralles A; Hospital de Sant Joan d'Alacant, Alacant, Spain., Sancho Chinesta S; Servicio de medicina intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Socias L; Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain., Solé-Violan J; Critical Care Department, Hospital Dr. Negrín Gran Canaria, Las Palmas, Gran Canaria, Spain., Suares Sipmann F; Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain., Tamayo Lomas L; Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain., Trenado J; Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain., Barbé F; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2021 Sep 13; Vol. 25 (1), pp. 331. Date of Electronic Publication: 2021 Sep 13.
DOI: 10.1186/s13054-021-03727-x
Abstrakt: Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission.
Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.
Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO 2 /FiO 2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO 2 /FiO 2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47).
Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO 2 /FiO 2 variation.
(© 2021. The Author(s).)
Databáze: MEDLINE
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