François Beloncle1,2, Antoine Studer3, Valérie Seegers4, Jean-Christophe Richard5,6, Christophe Desprez5, Nicolas Fage5, Hamid Merdji3,7, Bertrand Pavlovsky5, Julie Helms3,7, Sibylle Cunat3, Satar Mortaza5, Julien Demiselle5,3,7, Laurent Brochard8,9, Alain Mercat5, Ferhat Meziani3,7. 1. Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France. Francois.beloncle@univ-angers.fr. 2. CNRS, INSERM 1083, MITOVASC, University of Angers, Angers, France. Francois.beloncle@univ-angers.fr. 3. Medical ICU, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France. 4. Oncology Data Factory and Analytics, ICO Integrated Center for Oncology, Angers, France. 5. Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers, France. 6. INSERM, UMR 955 Eq 13, University of Paris-Est-Créteil, Créteil, France. 7. INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France. 8. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 9. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
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 (CRS), 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 cmH2O-1, p = 0.037). At day 1, CRS 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 CRS 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, CRS 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. CRS 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.
BACKGROUND: Differences in physiology of ARDS have been described between COVID-19 and non-COVID-19patients. This study aimed to compare initial values and longitudinal changes in respiratory system compliance (CRS), 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-19ARDS from two centers were included in a physiological study; 767 non-COVID-19ARDS 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-19patients had a higher body mass index, higher CRS at day 1 (median [IQR], 35 [28-44] vs 32 [26-38] ml cmH2O-1, p = 0.037). At day 1, CRS was correlated with oxygenation only in non-COVID-19patients; 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-19patients at days 3 and 7, while CRS became similar. VR was lower at day 1 in COVID-19 than in non-COVID-19patients but increased from day 1 to 7 only in COVID-19patients. VR was higher at days 1, 3 and 7 in the COVID-19patients ventilated using heat and moisture exchangers compared to heated humidifiers. After adjustment on PaO2/FiO2, PEEP and humidification device, CRS and VR were found not different between COVID-19 and non-COVID-19patients at day 7. Day-28 mortality did not differ between COVID-19 and non-COVID-19patients (25.9% and 23.7%, respectively, p = 0.666). CONCLUSIONS: For a similar initial oxygenation, COVID-19ARDS initially differs from classical ARDS by a higher CRS, dissociated from oxygenation. CRS become similar for patients remaining on mechanical ventilation during the first week of evolution, but oxygenation becomes lower in COVID-19patients. TRIAL REGISTRATION: clinicaltrials.gov NCT04385004.
Authors: Peter Burney; Jaymini Patel; Cosetta Minelli; Louisa Gnatiuc; André F S Amaral; Ali Kocabaş; Hamid Hacene Cherkaski; Amund Gulsvik; Rune Nielsen; Eric Bateman; Anamika Jithoo; Kevin Mortimer; Talant M Sooronbaev; Hervé Lawin; Chakib Nejjari; Mohammed Elbiaze; Karima El Rhazi; Jin-Ping Zheng; Pixin Ran; Tobias Welte; Daniel Obaseki; Gregory Erhabor; Asma Elsony; Nada Bakri Osman; Rana Ahmed; Ewa Nizankowska-Mogilnicka; Filip Mejza; David M Mannino; Cristina Bárbara; Emiel F M Wouters; Luisito F Idolor; Li-Cher Loh; Abdul Rashid; Sanjay Juvekar; Thorarinn Gislason; Mohamed Al Ghobain; Michael Studnicka; Imed Harrabi; Meriam Denguezli; Parvaiz A Koul; Christine Jenkins; Guy Marks; Rain Jõgi; Hasan Hafizi; Christer Janson; Wan C Tan; Althea Aquart-Stewart; Bertrand Mbatchou; Asaad Ahmed Nafees; Kirthi Gunasekera; Terry Seemungal; Mahesh Padukudru Anand; Paul Enright; William M Vollmer; Marta Blangiardo; Fadlalla G Elfadaly; A Sonia Buist Journal: Am J Respir Crit Care Med Date: 2021-06-01 Impact factor: 30.528
Authors: Marc Le Pape; Céline Besnard; Camelia Acatrinei; Jérôme Guinard; Maxime Boutrot; Claire Genève; Thierry Boulain; François Barbier Journal: Ann Intensive Care Date: 2022-03-15 Impact factor: 10.318