tetano
Editor, Senior Moderator
ERJ Open Res
. 2023 Apr 11;9(2):00554-2022.
doi: 10.1183/23120541.00554-2022. eCollection 2023 Mar.
Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality
Adel Maamar[SUP] 1 2 [/SUP], Pauline Guillot[SUP] 1 2 [/SUP], Vincent Joussellin[SUP] 1 2 [/SUP], Flora Delamaire[SUP] 1 2 [/SUP], Benoit Painvin[SUP] 1 2 [/SUP], Anaëlle Bichon[SUP] 1 2 [/SUP], Océane Bernard de la Jartre[SUP] 1 2 [/SUP], Matteo Mauget[SUP] 1 2 [/SUP], Mathieu Lesouhaitier[SUP] 1 2 3 [/SUP], Jean Marc Tadié[SUP] 1 2 3 [/SUP], Nicolas Terzi[SUP] 1 2 3 [/SUP], Arnaud Gacouin[SUP] 1 2 3 [/SUP]
Affiliations
Abstract
Background: This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P [SUB]aO[SUB]2[/SUB][/SUB] )/inspiratory oxygen fraction (F [SUB]IO[SUB]2[/SUB][/SUB] ) ≤150 mmHg.
Methods: We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C [SUB]rs[/SUB]), ventilator ratio, corrected minute ventilation (V'[SUB]Ecorr[/SUB]) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.
Results: On day 1 of ARDS, COVID-19 patients had significantly higher P [SUB]aO[SUB]2[/SUB][/SUB] /F [SUB]IO[SUB]2[/SUB][/SUB] (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH[SUB]2[/SUB]O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V'[SUB]Ecorr[/SUB] (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min[SUP]-1[/SUP]; p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P [SUB]aO[SUB]2[/SUB][/SUB] /F [SUB]IO[SUB]2[/SUB][/SUB] , arterial carbon dioxide tension, ventilatory ratio and V'[SUB]Ecorr[/SUB] differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43).
Conclusions: Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.
. 2023 Apr 11;9(2):00554-2022.
doi: 10.1183/23120541.00554-2022. eCollection 2023 Mar.
Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality
Adel Maamar[SUP] 1 2 [/SUP], Pauline Guillot[SUP] 1 2 [/SUP], Vincent Joussellin[SUP] 1 2 [/SUP], Flora Delamaire[SUP] 1 2 [/SUP], Benoit Painvin[SUP] 1 2 [/SUP], Anaëlle Bichon[SUP] 1 2 [/SUP], Océane Bernard de la Jartre[SUP] 1 2 [/SUP], Matteo Mauget[SUP] 1 2 [/SUP], Mathieu Lesouhaitier[SUP] 1 2 3 [/SUP], Jean Marc Tadié[SUP] 1 2 3 [/SUP], Nicolas Terzi[SUP] 1 2 3 [/SUP], Arnaud Gacouin[SUP] 1 2 3 [/SUP]
Affiliations
- PMID: 37041986
- PMCID: PMC9885245
- DOI: 10.1183/23120541.00554-2022
Abstract
Background: This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P [SUB]aO[SUB]2[/SUB][/SUB] )/inspiratory oxygen fraction (F [SUB]IO[SUB]2[/SUB][/SUB] ) ≤150 mmHg.
Methods: We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C [SUB]rs[/SUB]), ventilator ratio, corrected minute ventilation (V'[SUB]Ecorr[/SUB]) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.
Results: On day 1 of ARDS, COVID-19 patients had significantly higher P [SUB]aO[SUB]2[/SUB][/SUB] /F [SUB]IO[SUB]2[/SUB][/SUB] (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH[SUB]2[/SUB]O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V'[SUB]Ecorr[/SUB] (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min[SUP]-1[/SUP]; p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P [SUB]aO[SUB]2[/SUB][/SUB] /F [SUB]IO[SUB]2[/SUB][/SUB] , arterial carbon dioxide tension, ventilatory ratio and V'[SUB]Ecorr[/SUB] differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43).
Conclusions: Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.