An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

Media type: E-Article
Title: An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients
Contributor: Li Bassi, Gianluigi; Suen, Jacky Y.; Dalton, Heidi J.; White, Nicole; Shrapnel, Sally; Fanning, Jonathon P.; Liquet, Benoit; Hinton, Samuel; Vuorinen, Aapeli; Booth, Gareth; Millar, Jonathan E.; Forsyth, Simon; Panigada, Mauro; Laffey, John; Brodie, Daniel; Fan, Eddy; Torres, Antoni; Chiumello, Davide; Corley, Amanda; Elhazmi, Alyaa; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Murthy, Srinivas; [...]
imprint: Springer Science and Business Media LLC, 2021
Published in: Critical Care
Language: English
DOI: 10.1186/s13054-021-03518-4
ISSN: 1364-8535
Keywords: Critical Care and Intensive Care Medicine
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Heterogeneous respiratory system static compliance (<jats:italic>C</jats:italic><jats:sub>RS</jats:sub>) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (<jats:italic>p</jats:italic> = 0.417) nor with PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub> (<jats:italic>p</jats:italic> = 0.100). Females presented lower <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> than males (95% CI of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> difference between females-males: − 11.8 to − 7.4 mL/cmH<jats:sub>2</jats:sub>O <jats:italic>p</jats:italic> < 0.001), and although females presented higher body mass index (BMI), association of BMI with <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> was marginal (<jats:italic>p</jats:italic> = 0.139). Ventilatory management varied across <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> range, resulting in a significant association between <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> and driving pressure (estimated decrease − 0.31 cmH<jats:sub>2</jats:sub>O/L per mL/cmH<jats:sub>2</jats:sub>0 of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>, 95% CI − 0.48 to − 0.14, <jats:italic>p</jats:italic> < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> (+ 10 mL/cm H<jats:sub>2</jats:sub>O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, <jats:italic>p</jats:italic> = 0.018).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This multicentre report provides a comprehensive account of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> in COVID-19 patients on MV. <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.covid-critical.com/study">https://www.covid-critical.com/study</jats:ext-link>.</jats:p> <jats:p><jats:italic>Trial registration</jats:italic>: ACTRN12620000421932.</jats:p> </jats:sec>
Access State: Open Access

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