Epidemiology, Ventilation Management and Outcomes of COVID-19 ARDS Patients Versus Patients with ARDS Due to Pneumonia in the Pre-COVID Era

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2024 Aug 17

PMID 39153979

Authors

Fleur-Stefanie L I M van der Ven

Siebe G Blok

Luciano C Azevedo

Giacomo Bellani

Michela Botta

Elisa Estenssoro

Eddy Fan

Juliana Carvalho Ferreira

John G Laffey

Ignacio Martin-Loeches

Ana Motos

Tai Pham

Oscar Penuelas

Antonio Pesenti

Luigi Pisani

Ary Serpa Neto

Marcus J Schultz

Antoni Torres

Anissa M Tsonas

Frederique Paulus

David M P van Meenen

Affiliations

Soon will be listed here.

Abstract

Background: Ventilation management may differ between COVID-19 ARDS (COVID-ARDS) patients and patients with pre-COVID ARDS (CLASSIC-ARDS); it is uncertain whether associations of ventilation management with outcomes for CLASSIC-ARDS also exist in COVID-ARDS.

Methods: Individual patient data analysis of COVID-ARDS and CLASSIC-ARDS patients in six observational studies of ventilation, four in the COVID-19 pandemic and two pre-pandemic. Descriptive statistics were used to compare epidemiology and ventilation characteristics. The primary endpoint were key ventilation parameters; other outcomes included mortality and ventilator-free days and alive (VFD-60) at day 60.

Results: This analysis included 6702 COVID-ARDS patients and 1415 CLASSIC-ARDS patients. COVID-ARDS patients received lower median V (6.6 [6.0 to 7.4] vs 7.3 [6.4 to 8.5] ml/kg PBW; p < 0.001) and higher median PEEP (12.0 [10.0 to 14.0] vs 8.0 [6.0 to 10.0] cm HO; p < 0.001), at lower median ΔP (13.0 [10.0 to 15.0] vs 16.0 [IQR 12.0 to 20.0] cm HO; p < 0.001) and higher median Crs (33.5 [26.6 to 42.1] vs 28.1 [21.6 to 38.4] mL/cm HO; p < 0.001). Following multivariable adjustment, higher ΔP had an independent association with higher 60-day mortality and less VFD-60 in both groups. Higher PEEP had an association with less VFD-60, but only in COVID-ARDS patients.

Conclusions: Our findings show important differences in key ventilation parameters and associations thereof with outcomes between COVID-ARDS and CLASSIC-ARDS.

Trial Registration: Clinicaltrials.gov (identifier NCT05650957), December 14, 2022.

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References

Zampieri F, Costa E, Iwashyna T, Carvalho C, Damiani L, Taniguchi L . Heterogeneous effects of alveolar recruitment in acute respiratory distress syndrome: a machine learning reanalysis of the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial. Br J Anaesth. 2019; 123(1):88-95. DOI: 10.1016/j.bja.2019.02.026. View

Schuijt M, Hol L, Nijbroek S, Ahuja S, van Meenen D, Mazzinari G . Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications-posthoc analysis of two randomised clinical trials in open abdominal surgery. EClinicalMedicine. 2022; 47:101397. PMC: 9035701. DOI: 10.1016/j.eclinm.2022.101397. View

van Meenen D, Algera A, Schuijt M, Simonis F, van der Hoeven S, Serpa Neto A . Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome: An analysis of three randomised clinical trials. Eur J Anaesthesiol. 2022; 40(1):21-28. DOI: 10.1097/EJA.0000000000001778. View

Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O . Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016; 42(10):1567-1575. DOI: 10.1007/s00134-016-4505-2. View

Brown-Brumfield D, DeLeon A . Adherence to a medication safety protocol: current practice for labeling medications and solutions on the sterile field. AORN J. 2010; 91(5):610-7. DOI: 10.1016/j.aorn.2010.03.002. View

Laffey J, Bellani G, Pham T, Fan E, Madotto F, Bajwa E . Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016; 42(12):1865-1876. DOI: 10.1007/s00134-016-4571-5. View

Ferreira J, Besen B, Malbuisson L, Taniguchi L, Mendes P, Costa E . Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol. Clinics (Sao Paulo). 2020; 75:e2294. PMC: 7442378. DOI: 10.6061/clinics/2020/e2294. View

Amato M, Meade M, Slutsky A, Brochard L, Costa E, Schoenfeld D . Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372(8):747-55. DOI: 10.1056/NEJMsa1410639. View

Le Pape M, Besnard C, Acatrinei C, Guinard J, Boutrot M, Geneve C . Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study. Ann Intensive Care. 2022; 12(1):24. PMC: 8922395. DOI: 10.1186/s13613-022-00998-7. View

10.

Estenssoro E, Loudet C, Rios F, Kanoore Edul V, Plotnikow G, Andrian M . Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study. Lancet Respir Med. 2021; 9(9):989-998. PMC: 8253540. DOI: 10.1016/S2213-2600(21)00229-0. View

11.

Azevedo L, Park M, Salluh J, Rea-Neto A, Souza-Dantas V, Varaschin P . Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013; 17(2):R63. PMC: 3672504. DOI: 10.1186/cc12594. View

12.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A . Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581. PMC: 7136855. DOI: 10.1001/jama.2020.5394. View

13.

Tsolaki V, Zakynthinos G, Makris D . The ARDSnet protocol may be detrimental in COVID-19. Crit Care. 2020; 24(1):351. PMC: 7296518. DOI: 10.1186/s13054-020-03081-4. View

14.

van Meenen D, Serpa Neto A, Paulus F, Merkies C, Schouten L, Bos L . The predictive validity for mortality of the driving pressure and the mechanical power of ventilation. Intensive Care Med Exp. 2020; 8(Suppl 1):60. PMC: 7746416. DOI: 10.1186/s40635-020-00346-8. View

15.

Costa E, Slutsky A, Brochard L, Brower R, Serpa-Neto A, Cavalcanti A . Ventilatory Variables and Mechanical Power in Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2021; 204(3):303-311. DOI: 10.1164/rccm.202009-3467OC. View

16.

Bellani G, Laffey J, Pham T, Fan E, Brochard L, Esteban A . Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016; 315(8):788-800. DOI: 10.1001/jama.2016.0291. View

17.

Gattinoni L, Chiumello D, Rossi S . COVID-19 pneumonia: ARDS or not?. Crit Care. 2020; 24(1):154. PMC: 7160817. DOI: 10.1186/s13054-020-02880-z. View

18.

Nolley E, Sahetya S, Hochberg C, Hossen S, Hager D, Brower R . Outcomes Among Mechanically Ventilated Patients With Severe Pneumonia and Acute Hypoxemic Respiratory Failure From SARS-CoV-2 and Other Etiologies. JAMA Netw Open. 2023; 6(1):e2250401. PMC: 9856712. DOI: 10.1001/jamanetworkopen.2022.50401. View

19.

Sjoding M, Admon A, Saha A, Kay S, Brown C, Co I . Comparing Clinical Features and Outcomes in Mechanically Ventilated Patients with COVID-19 and Acute Respiratory Distress Syndrome. Ann Am Thorac Soc. 2021; 18(11):1876-1885. PMC: 8641825. DOI: 10.1513/AnnalsATS.202008-1076OC. View

20.

Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G . Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med. 2020; 8(12):1201-1208. PMC: 7834127. DOI: 10.1016/S2213-2600(20)30370-2. View