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 |
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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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