Background: Both coronavirus disease 2019 (COVID-19) and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERS patients with ARDS to evaluate this issue. Methods: MERS patients with ARDS seen during the March to May 2014 outbreak and COVID-19 patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared. Results: Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO2, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were high and reflective of their baseline comorbid status. Conclusion: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients might explain the greater steroid responsiveness in this population.
Background: Both coronavirus disease 2019 (COVID-19) and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERSpatients with ARDS to evaluate this issue. Methods:MERSpatients with ARDS seen during the March to May 2014 outbreak and COVID-19patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared. Results: Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22). COVID-19patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO2, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERSpatients (P≥0.54) were high and reflective of their baseline comorbid status. Conclusion: Despite some distinctive differences between COVID-19 and MERSpatients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19patients might explain the greater steroid responsiveness in this population.
Authors: Imran Khalid; Mohammad Saeedi; Elaf M Alzarnougi; Abdullah Alraddadi; Afnan Afifi; Maryam Imran; Abeer N Alshukairi; Muhammad Ali Akhtar; Manahil Imran; Tabindeh Jabeen Khalid Journal: Int J Health Sci (Qassim) Date: 2022 Jan-Feb