tetano
Editor, Senior Moderator
Intensive Care Med
. 2020 Jul 29.
doi: 10.1007/s00134-020-06192-2. Online ahead of print.
Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS
Carlos Ferrando[SUP] 1 2 [/SUP], Fernando Suarez-Sipmann[SUP] 3 4 5 [/SUP], Ricard Mellado-Artigas[SUP] 6 [/SUP], Mar?a Hern?ndez[SUP] 7 [/SUP], Alfredo Gea[SUP] 8 [/SUP], Egoitz Arruti[SUP] 9 [/SUP], C?sar Aldecoa[SUP] 10 [/SUP], Graciela Mart?nez-Pall?[SUP] 6 [/SUP], Miguel A Mart?nez-Gonz?lez[SUP] 11 12 [/SUP], Arthur S Slutsky[SUP] 13 14 [/SUP], Jes?s Villar[SUP] 3 13 15 [/SUP], COVID-19 Spanish ICU Network
Collaborators, Affiliations
Abstract
Purpose: The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV).
Methods: This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients.
Results: A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH[SUB]2[/SUB]O. Values of respiratory system compliance 35 (27-45) ml/cmH[SUB]2[/SUB]O, plateau pressure 25 (22-29) cmH[SUB]2[/SUB]O, and driving pressure 12 (10-16) cmH[SUB]2[/SUB]O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients.
Conclusions: In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.
. 2020 Jul 29.
doi: 10.1007/s00134-020-06192-2. Online ahead of print.
Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS
Carlos Ferrando[SUP] 1 2 [/SUP], Fernando Suarez-Sipmann[SUP] 3 4 5 [/SUP], Ricard Mellado-Artigas[SUP] 6 [/SUP], Mar?a Hern?ndez[SUP] 7 [/SUP], Alfredo Gea[SUP] 8 [/SUP], Egoitz Arruti[SUP] 9 [/SUP], C?sar Aldecoa[SUP] 10 [/SUP], Graciela Mart?nez-Pall?[SUP] 6 [/SUP], Miguel A Mart?nez-Gonz?lez[SUP] 11 12 [/SUP], Arthur S Slutsky[SUP] 13 14 [/SUP], Jes?s Villar[SUP] 3 13 15 [/SUP], COVID-19 Spanish ICU Network
Collaborators, Affiliations
- PMID: 32728965
- DOI: 10.1007/s00134-020-06192-2
Abstract
Purpose: The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV).
Methods: This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients.
Results: A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH[SUB]2[/SUB]O. Values of respiratory system compliance 35 (27-45) ml/cmH[SUB]2[/SUB]O, plateau pressure 25 (22-29) cmH[SUB]2[/SUB]O, and driving pressure 12 (10-16) cmH[SUB]2[/SUB]O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients.
Conclusions: In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.