Benoit Vandenbunder1, Stephan Ehrmann2, Jean-Baptiste Lascarrou3, David Grimaldi4, Michael Piagnerelli5, Bertrand Sauneuf6, Nicolas Serck7, Thibaud Soumagne8, Julien Textoris9,10, Christophe Vinsonneau11, Nadia Aissaoui12, Gauthier Blonz13, Giuseppe Carbutti14, Romain Courcelle15, Alain D'hondt16, Stephane Gaudry17, Julien Higny18, Geoffroy Horlait19, Sami Hraiech20,21, Laurent Lefebvre22, Francois Lejeune23, Andre Ly24. 1. Groupe des anesthésistes réanimateurs, Hôpital Privé d'Antony, Antony, France. 2. CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSEP research network, and INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France. 3. Médecine Intensive Réanimation, CHU Nantes, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 9, France. 4. Soins Intensifs, Hôpital Erasme, ULB, Route de Lennik 808, 1070, Bruxelles, Belgium. david.grimaldi@erasme.ulb.ac.be. 5. Intensive Care, CHU-Charleroi, Marie Curie, Université Libre de Bruxelles, 140, chaussée de Bruxelles, 6042, Charleroi, Belgium. 6. Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, BP208, 50102, Cherbourg-en-Cotentin, France. 7. Unité de soins intensifs, Clinique Saint Pierre, Ottignies, Belgium. 8. Médecine Intensive Réanimation, CHU Besançon, 3 Boulevard FLEMING, 25030, Besançon, France. 9. Service de réanimation, Hospices Civils de Lyon, 5 Place D'Arsonval, Lyon, France. 10. Laboratoire Commun de Recherche bioMérieux-Hospices Civils de Lyon, Université de Lyon 1, EA7426 PI3, Lyon, France. 11. Service de Médecine Intensive Réanimation Unité de Sevrage Ventilatoire Et Réhabilitation Centre Hospitalier de BETHUNE, 27 Rue Delbecque, 62660, Beuvry, France. 12. Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Paris Centre U 970 PARCC, Paris, France. 13. Médecine Intensive Reanimation, District Hospital Center, Boulevard Stephane Moreau, 85000, La Roche Sur Yon, France. 14. Unité de Soins Intensifs, CHR Mons-Hainaut, Mons, Belgium. 15. Unité de Soins Intensifs, Centres Hospitaliers de Jolimont, La Louvière, Belgium. 16. Unité de Soins Intensifs, CHU Ambroise Paré, Mons, Belgium. 17. Réanimation médico-Chirurgicale CHU Avicennes, Université Sorbonne Paris Nord, Bobigny, France. 18. Unité de Soins Intensifs, CHU Dinant Godinne, Site Dinant, Dinant, Belgium. 19. Unité de Soins Intensifs, CHU Dinant Godinne, Site Godinne, Yvoir, Belgium. 20. Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, 13015, Marseille, France. 21. Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Faculté de médecine, Marseille Université, 13005, Marseille, France. 22. Réanimation Polyvalente Centre Hospitalier du Pays D'Aix, Aix en Provence, France. 23. Unité de Soins Intensifs, Clinique Notre Dame de Grâce, Gosselies, Belgium. 24. Service D'anesthésie-réanimation Chirurgicale, Unité de réanimation Chirurgicale Polyvalente, Hôpitaux Universitaires Henri Mondor, Créteil, France.
Abstract
BACKGROUND: Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. METHODS: In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. RESULTS: The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98-1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13-3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88-0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome. CONCLUSION: In a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.
BACKGROUND: Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. METHODS: In this observational multicenter cohort of patients with moderate to severe Covid-19ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. RESULTS: The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98-1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13-3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88-0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome. CONCLUSION: In a large multicenter cohort of moderate to severe COVID-19ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.
Authors: Filip Depta; Pavol Török; Andrew G Miller; Peter Firment; Jozef Leškanič; Adam Porubän; Pavol Halaš; Stanislav Mandinec; Vladimír Filka; Henryk Zajac; Michael A Gentile; Marko Zdravkovic Journal: J Int Med Res Date: 2022-05 Impact factor: 1.573