학술논문
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome.
Document Type
Academic Journal
Author
Beloncle F; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France. Francois.beloncle@univ-angers.fr.; CNRS, INSERM 1083, MITOVASC, University of Angers, Angers, France. Francois.beloncle@univ-angers.fr.; Studer A; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; Seegers V; Oncology Data Factory and Analytics, ICO Integrated Center for Oncology, Angers, France.; Richard JC; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; INSERM, UMR 955 Eq 13, University of Paris-Est-Créteil, Créteil, France.; Desprez C; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Fage N; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Merdji H; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.; Pavlovsky B; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Helms J; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.; Cunat S; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; Mortaza S; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Demiselle J; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.; Brochard L; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Mercat A; Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France.; Meziani F; Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
Source
Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE
Subject
Language
English
Abstract
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 (C RS ), 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 cmH 2 O -1 , p = 0.037). At day 1, C RS 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 C RS 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 PaO 2 /FiO 2 , PEEP and humidification device, C RS 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. C RS 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.
(© 2021. The Author(s).)
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 C
Conclusions: For a similar initial oxygenation, COVID-19 ARDS initially differs from classical ARDS by a higher C
Trial Registration: clinicaltrials.gov NCT04385004.
(© 2021. The Author(s).)