Annalisa Boscolo1, Nicolò Sella2, Giulia Lorenzoni3, Tommaso Pettenuzzo1, Laura Pasin1, Chiara Pretto2, Martina Tocco2, Enrico Tamburini2, Alessandro De Cassai1, Paolo Rosi4, Enrico Polati5, Katia Donadello5, Leonardo Gottin5, Silvia De Rosa6, Fabio Baratto7, Fabio Toffoletto8, V Marco Ranieri9, Dario Gregori3, Paolo Navalesi10,11. 1. Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy. 2. Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy. 3. Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University School of Medicine, Padua, Italy. 4. Emergency Medical Services, Regional Department, AULSS 3, Venice, Italy. 5. Anesthesia and Intensive Care Unit B, Verona University Hospital, Verona, Italy. 6. Anesthesia and Critical Care Unit, San Bortolo Hospital, Vicenza, Italy. 7. Anesthesia and Intensive Care Unit, Ospedale Riuniti Padova Sud, Schiavonia, Italy. 8. Anesthesia and Intensive Care Unit, Ospedali di San Donà di Piave e Jesolo, San Donà di Piave, Italy. 9. Anesthesia and Intensive Care Medicine, Department of Medical and Surgical Science, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. 10. Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy. paolo.navalesi@unipd.it. 11. Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy. paolo.navalesi@unipd.it.
Abstract
BACKGROUND: Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. METHODS: Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. RESULTS: A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings. CONCLUSIONS: Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.
BACKGROUND: Pathophysiological features of coronavirus disease2019-associated acute respiratory distress syndrome (COVID-19ARDS) were indicated to be somewhat different from those described in nonCOVID-19ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19ARDS. METHODS: Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. RESULTS: A total of 704 COVID-19patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings. CONCLUSIONS:Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.
Authors: V Marco Ranieri; Gordon D Rubenfeld; B Taylor Thompson; Niall D Ferguson; Ellen Caldwell; Eddy Fan; Luigi Camporota; Arthur S Slutsky Journal: JAMA Date: 2012-06-20 Impact factor: 56.272