tetano
Editor, Senior Moderator
J Crit Care
. 2021 Jul 7;65:237-245.
doi: 10.1016/j.jcrc.2021.06.016. Online ahead of print.
Mortality associated with early changes in ARDS severity in COVID-19 patients - Insights from the PRoVENT-COVID study
Michiel T U Schuijt[SUP] 1 [/SUP], Ignacio Martin-Loeches[SUP] 2 [/SUP], Marcus J Schultz[SUP] 3 [/SUP], Frederique Paulus[SUP] 4 [/SUP], Ary Serpa Neto[SUP] 5 [/SUP], PRoVENT–COVID; Collaborative Group members. Electronic address: [email]provent-covid@amsterdamumc.nl[/email]
Affiliations
Abstract
Purpose: We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.
Methods: We compared outcomes in patients with ARDS classified as 'mild', 'moderate' or 'severe' at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28-day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4.
Results: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28-day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4.
Conclusions: In this cohort of COVID-19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
Keywords: ARDS; Acute respiratory distress syndrome; COVID–19; Coronavirus disease 2019; Mortality.
. 2021 Jul 7;65:237-245.
doi: 10.1016/j.jcrc.2021.06.016. Online ahead of print.
Mortality associated with early changes in ARDS severity in COVID-19 patients - Insights from the PRoVENT-COVID study
Michiel T U Schuijt[SUP] 1 [/SUP], Ignacio Martin-Loeches[SUP] 2 [/SUP], Marcus J Schultz[SUP] 3 [/SUP], Frederique Paulus[SUP] 4 [/SUP], Ary Serpa Neto[SUP] 5 [/SUP], PRoVENT–COVID; Collaborative Group members. Electronic address: [email]provent-covid@amsterdamumc.nl[/email]
Affiliations
- PMID: 34271294
- PMCID: PMC8260578
- DOI: 10.1016/j.jcrc.2021.06.016
Abstract
Purpose: We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.
Methods: We compared outcomes in patients with ARDS classified as 'mild', 'moderate' or 'severe' at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28-day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4.
Results: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28-day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4.
Conclusions: In this cohort of COVID-19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
Keywords: ARDS; Acute respiratory distress syndrome; COVID–19; Coronavirus disease 2019; Mortality.