An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

Critical Care

the COVID-19 Critical Care Consortium¹  John Laffey²  Nicole White³  Alistair Nichol⁴  John F. Fraser⁵  Jacky Y. Suen⁵  Amanda Corley⁵  Gianluigi Li Bassi⁵  Jonathon P. Fanning⁵  Daniel Brodie⁶  Srinivas Murthy⁷  Antonio Pesenti⁸  Mauro Panigada⁸  Davide Chiumello⁹  Huynh Trung Trieu^1,10  Heidi J. Dalton^1,11  Antoni Torres^1,12  Shingo Ichiba^1,13  Eddy Fan^1,14  Alyaa Elhazmi^1,15  Mark Ogino^1,16  Carlos Luna^1,17  Jonathan E. Millar^1,18  Carol Hodgson^1,19  Pauline Yeung Ng^2,20  Sally Shrapnel^2,21  Benoit Liquet^2,21  Aapeli Vuorinen^2,21  Gareth Booth^2,21  Simon Forsyth^2,21  Samuel Hinton^2,21 

[1] ;Anaesthesia and Intensive Care Medicine, National University of Ireland;Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT);Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University;Critical Care Research Group, The Prince Charles Hospital;Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital;Department of Pediatrics, Faculty of Medicine, University of British Columbia;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano;Hospital Clinic of Barcelona;Hospital for Tropical Diseases;INOVA Fairfax Medical Center, Heart and Vascular Institute;Institut d’Investigacions Biomèdiques August Pi i Sunyer;Intensive Care, Nippon Medical School Hospital;Interdepartmental Division of Critical Care Medicine, University of Toronto;King Faisal Specialist Hospital and Research Centre;Nemours Alfred I duPont Hospital for Children;Neumonología, Hospital de Clínicas, UBA;Roslin Institute, University of Edinburgh;The Alfred Hospital;The University of Hong Kong;University of Queensland;

关键词: Mechanical ventilation;    Compliance;    ARDS;    COVID-19;    SARS-CoV-2;   

DOI  :  10.1186/s13054-021-03518-4

来源: DOAJ

【 摘 要 】

Abstract Background Heterogeneous respiratory system static compliance (C RS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe C RS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of C RS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). C RS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower C RS than males (95% CI of C RS difference between females-males: − 11.8 to − 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with C RS was marginal (p = 0.139). Ventilatory management varied across C RS range, resulting in a significant association between C RS and driving pressure (estimated decrease − 0.31 cmH2O/L per mL/cmH20 of C RS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that C RS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018). Conclusions This multicentre report provides a comprehensive account of C RS in COVID-19 patients on MV. C RS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study . Trial registration: ACTRN12620000421932.

【 授权许可】

Unknown