Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome

Autor: Ferhat Meziani, Julien Demiselle, Nicolas Fage, Antoine Studer, Sibylle Cunat, Jean-Christophe Richard, Alain Mercat, François Beloncle, Satar Mortaza, Hamid Merdji, Laurent Brochard, Bertrand Pavlovsky, Christophe Desprez, Julie Helms, Valérie Seegers
Přispěvatelé: Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Strasbourg, Université de Strasbourg (UNISTRA), Integrated Center for Oncology [Angers] (ICO), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), LUNAM Université [Nantes Angers Le Mans], Regenerative NanoMedicine [Strasbourg] (RNM), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), St. Michael's Hospital, University of Toronto, RICHARD, Jean-Christophe, Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
ARDS
Letter
Coronavirus disease 2019 (COVID-19)
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Respiratory mechanics
Respiratory failure
Critical Care and Intensive Care Medicine
Severity of Illness Index
Body Mass Index
Positive-Pressure Respiration
03 medical and health sciences
Dead space
0302 clinical medicine
Mechanical ventilation
Medicine
Humans
030212 general & internal medicine
Respiratory system
Propensity Score
Acute Respiratory Distress Syndrome
Aged
Respiratory Distress Syndrome
Pulmonary Gas Exchange
business.industry
SARS-CoV-2
RC86-88.9
Research
Medical emergencies. Critical care. Intensive care. First aid
Oxygenation
Middle Aged
medicine.disease
Respiration
Artificial
Respiratory Function Tests
[SDV] Life Sciences [q-bio]
Compliance (physiology)
Clinical trial
Intensive Care Units
030228 respiratory system
Anesthesia
Female
Blood Gas Analysis
business
Covid-19
Body mass index
Zdroj: Critical Care, Vol 25, Iss 1, Pp 1-10 (2021)
Critical Care
Critical Care, 2021, 25 (1), pp.248. ⟨10.1186/s13054-021-03665-8⟩
Critical Care, BioMed Central, 2021, 25 (1), pp.248. ⟨10.1186/s13054-021-03665-8⟩
ISSN: 1364-8535
0438-5004
1466-609X
Popis: Background Differences in physiology of ARDS have been described between COVID-19 and non-COVID-19 patients. This study aimed to compare initial values and longitudinal changes in respiratory system compliance (CRS), oxygenation parameters and ventilatory ratio (VR) in patients with COVID-19 and non-COVID-19 pulmonary ARDS matched on oxygenation. Methods 135 patients with COVID-19 ARDS from two centers were included in a physiological study; 767 non-COVID-19 ARDS from a clinical trial were used for the purpose of at least 1:2 matching. A propensity-matching was based on age, severity score, oxygenation, positive end-expiratory pressure (PEEP) and pulmonary cause of ARDS and allowed to include 112 COVID-19 and 198 non-COVID pulmonary ARDS. Results The two groups were similar on initial oxygenation. COVID-19 patients had a higher body mass index, higher CRS at day 1 (median [IQR], 35 [28–44] vs 32 [26–38] ml cmH2O−1, p = 0.037). At day 1, CRS was correlated with oxygenation only in non-COVID-19 patients; 61.6% and 68.2% of COVID-19 and non-COVID-19 pulmonary ARDS were still ventilated at day 7 (p = 0.241). Oxygenation became lower in COVID-19 than in non-COVID-19 patients at days 3 and 7, while CRS became similar. VR was lower at day 1 in COVID-19 than in non-COVID-19 patients but increased from day 1 to 7 only in COVID-19 patients. VR was higher at days 1, 3 and 7 in the COVID-19 patients ventilated using heat and moisture exchangers compared to heated humidifiers. After adjustment on PaO2/FiO2, PEEP and humidification device, CRS and VR were found not different between COVID-19 and non-COVID-19 patients at day 7. Day-28 mortality did not differ between COVID-19 and non-COVID-19 patients (25.9% and 23.7%, respectively, p = 0.666). Conclusions For a similar initial oxygenation, COVID-19 ARDS initially differs from classical ARDS by a higher CRS, dissociated from oxygenation. CRS become similar for patients remaining on mechanical ventilation during the first week of evolution, but oxygenation becomes lower in COVID-19 patients. Trial registration: clinicaltrials.gov NCT04385004
Databáze: OpenAIRE
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