Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS

Abstract

The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods: This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results: A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH 2 O. Values of respiratory system compliance 35 (27-45) ml/cmH 2 O, plateau pressure 25 (22-29) cmH 2 O, and driving pressure 12 (10-16) cmH 2 O were similar to values from non-COVID-19 ARDS patients observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions: In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.

Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study

“…Published studies on the management of ARF in COVID-19 patients have shown that the vast majority need invasive MV with prolonged times on the ventilator [19,20]. Alternatives to invasive respiratory support such as HFNO, a simple technique with few side effects, have been widely used during the pandemic.…”

Awake Prone Positioning Does Not Reduce the Risk of Intubation in COVID-19 Treated with High-Flow Nasal Oxygen Therapy. A Multicenter, Adjusted Cohort Study

“…Published studies on the management of ARF in COVID-19 patients have shown that the vast majority need invasive MV with prolonged times on the ventilator. 19,20 Alternatives to invasive respiratory support such as HFNO, a simple technique with few side effects, have been widely used during the pandemic to manage severe hypoxemia, despite initial concerns about the possibility of increased risk of virus transmission. Other adjunctive techniques, such as awake-PP, have been widely used in combination with oxygen therapy, NIV or HFNO to correct hypoxemia and avoid the need for invasive MV.…”

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study

“…We have reported [2,3] that severe hypoxemia with relatively well-preserved respiratory system compliance (Crs) measured under standard conditions is characteristic of COVID-19-ARDS, and it differs from ARDS of other causes (typical ARDS), while others did not recognize consistent differences [4][5][6][7]. However, the increased frequency of higher Crs in COVID-19-ARDS was noted by some of the same authors [4,5], and a significantly higher Crs associated with severe hypoxemia was recently documented [8]. The heterogeneous nature of ARDS allows that-at the population level-there may be wide overlap between COVID-19-ARDS and typical ARDS, and these observations continue to drive a debate [6,9].…”