Rapidly improving acute respiratory distress syndrome in COVID-19: a multi-centre observational study

Respiratory Research

Epaminondas Zakynthinos¹  George E. Zakynthinos¹  Vasiliki Tsolaki¹  Katerina Vaporidi²  Dimitris Georgopoulos²  Nikos Tserlikakis²  Edward J. Schenck³  Ilias I. Siempos⁴  Eleni Papoutsi⁴  Athina G. Mantelou⁴  Dimitrios Karayiannis⁴  Christina Routsi⁴  Spyros G. Zakynthinos⁴  Evdokia Gavrielatou⁴  Zafeiria Mastora⁴  Anastasia Kotanidou⁴  Aikaterini Maragkuti⁴ 

[1] Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly;Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete;Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine;First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School;

关键词: Coronavirus;    Acute respiratory failure;    Trajectory;    Pneumonia;    Acute respiratory distress syndrome;   

DOI  :  10.1186/s12931-022-02015-8

来源: DOAJ

【 摘 要 】

Abstract Background Before the pandemic of coronavirus disease (COVID-19), rapidly improving acute respiratory distress syndrome (ARDS), mostly defined by early extubation, had been recognized as an increasingly prevalent subphenotype (making up 15–24% of all ARDS cases), associated with good prognosis (10% mortality in ARDSNet trials). We attempted to determine the prevalence and prognosis of rapidly improving ARDS and of persistent severe ARDS related to COVID-19. Methods We included consecutive patients with COVID-19 receiving invasive mechanical ventilation in three intensive care units (ICU) during the second pandemic wave in Greece. We defined rapidly improving ARDS as extubation or a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO2:FiO2 of equal to or less than 100 on the second day following intubation. Results A total of 280 intubated patients met criteria of ARDS with a median PaO2:FiO2 of 125.0 (interquartile range 93.0–161.0) on day of intubation, and overall ICU-mortality of 52.5% (ranging from 24.3 to 66.9% across the three participating sites). Prevalence of rapidly improving ARDS was 3.9% (11 of 280 patients); no extubation occurred on the first day following intubation. ICU-mortality of patients with rapidly improving ARDS was 54.5%. This low prevalence and high mortality rate of rapidly improving ARDS were consistent across participating sites. Prevalence of persistent severe ARDS was 12.1% and corresponding mortality was 82.4%. Conclusions Rapidly improving ARDS was not prevalent and was not associated with good prognosis among patients with COVID-19. This is starkly different from what has been previously reported for patients with ARDS not related to COVID-19. Our results on both rapidly improving ARDS and persistent severe ARDS may contribute to our understanding of trajectory of ARDS and its association with prognosis in patients with COVID-19.

【 授权许可】

Unknown