Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome
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-...
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doaj-d8865fbee26d49d49969c5f7b910ae472021-07-18T11:04:09ZengBMCCritical Care1364-85352021-07-0125111010.1186/s13054-021-03665-8Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndromeFrançois Beloncle0Antoine Studer1Valérie Seegers2Jean-Christophe Richard3Christophe Desprez4Nicolas Fage5Hamid Merdji6Bertrand Pavlovsky7Julie Helms8Sibylle Cunat9Satar Mortaza10Julien Demiselle11Laurent Brochard12Alain Mercat13Ferhat Meziani14Medical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Strasbourg, University of StrasbourgOncology Data Factory and Analytics, ICO Integrated Center for OncologyMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Strasbourg, University of StrasbourgMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Strasbourg, University of StrasbourgMedical ICU, University Hospital of Strasbourg, University of StrasbourgMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersKeenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s HospitalMedical ICU, University Hospital of Angers, Vent’Lab, University of AngersMedical ICU, University Hospital of Strasbourg, University of StrasbourgAbstract 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 C RS at day 1 (median [IQR], 35 [28–44] vs 32 [26–38] ml cmH2O−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 PaO2/FiO2, 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 C RS, 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 NCT04385004https://doi.org/10.1186/s13054-021-03665-8Mechanical ventilationRespiratory failureRespiratory mechanicsDead spaceAcute Respiratory Distress SyndromeCovid-19 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
François Beloncle Antoine Studer Valérie Seegers Jean-Christophe Richard Christophe Desprez Nicolas Fage Hamid Merdji Bertrand Pavlovsky Julie Helms Sibylle Cunat Satar Mortaza Julien Demiselle Laurent Brochard Alain Mercat Ferhat Meziani |
spellingShingle |
François Beloncle Antoine Studer Valérie Seegers Jean-Christophe Richard Christophe Desprez Nicolas Fage Hamid Merdji Bertrand Pavlovsky Julie Helms Sibylle Cunat Satar Mortaza Julien Demiselle Laurent Brochard Alain Mercat Ferhat Meziani Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome Critical Care Mechanical ventilation Respiratory failure Respiratory mechanics Dead space Acute Respiratory Distress Syndrome Covid-19 |
author_facet |
François Beloncle Antoine Studer Valérie Seegers Jean-Christophe Richard Christophe Desprez Nicolas Fage Hamid Merdji Bertrand Pavlovsky Julie Helms Sibylle Cunat Satar Mortaza Julien Demiselle Laurent Brochard Alain Mercat Ferhat Meziani |
author_sort |
François Beloncle |
title |
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome |
title_short |
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome |
title_full |
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome |
title_fullStr |
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome |
title_full_unstemmed |
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome |
title_sort |
longitudinal changes in compliance, oxygenation and ventilatory ratio in covid-19 versus non-covid-19 pulmonary acute respiratory distress syndrome |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2021-07-01 |
description |
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 C RS at day 1 (median [IQR], 35 [28–44] vs 32 [26–38] ml cmH2O−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 PaO2/FiO2, 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 C RS, 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 |
topic |
Mechanical ventilation Respiratory failure Respiratory mechanics Dead space Acute Respiratory Distress Syndrome Covid-19 |
url |
https://doi.org/10.1186/s13054-021-03665-8 |
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