Respiratory Mechanics and Gas Exchange in COVID-19–associated Respiratory Failure

Schenck, Edward J.; Hoffman, Katherine L.; Goyal, Parag; Choi, Justin; Torres, Lisa; Rajwani, Kapil; Tam, Christopher W.; Ivascu, Natalia S.; Martínez, Fernando J.; Berlin, David

doi:10.1513/annalsats.202005-427rl

Cited by 118 publications

(151 citation statements)

References 12 publications

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“…2 ). The respiratory compliance noted in both the groups was comparable with those reported in earlier cohorts ( 2 , 9 , 10 ). This variability in respiratory mechanics suggests a significant heterogeneity in the disease process as described earlier by Gattinoni et al ( 11 ), although the lung compliance in their group was much higher ( 9 ).…”

Section: To the Editorsupporting

confidence: 88%

“…Sequential Organ Failure Assessment (SOFA) score has been associated with higher mortality among patients admitted to the ICU ( 10 ). In our study, the patients who required early intubation had a significantly higher SOFA score on hospital admission and ICU admission when compared with the late intubation group (6.51 vs 3.48; p ≤ 0.0001) and (8.15 vs 6.29 p = 0.005), respectively.…”

Section: To the Editormentioning

confidence: 99%

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Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

Matta

Chaudhary

et al. 2020

Critical Care Explorations

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Section: To the Editorsupporting

confidence: 88%

Section: To the Editormentioning

confidence: 99%

Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

Matta

Chaudhary

et al. 2020

Critical Care Explorations

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Purpose: To investigate whether COVID-19-ARDS differs from all-cause ARDS. Methods: Thirty-two consecutive, mechanically ventilated COVID-19-ARDS patients were compared to two historical ARDS sub-populations 1:1 matched for PaO 2 /FiO 2 or for compliance of the respiratory system. Gas exchange, hemodynamics and respiratory mechanics were recorded at 5 and 15 cmH 2 O PEEP. CT scan variables were measured at 5 cmH 2 O PEEP. Results: Anthropometric characteristics were similar in COVID-19-ARDS, PaO 2 /FiO 2-matched-ARDS and Compliance-matched-ARDS. The PaO 2 /FiO 2-matched-ARDS and COVID-19-ARDS populations (both with PaO 2 /FiO 2 106 ± 59 mmHg) had different respiratory system compliances (Crs) (39 ± 11 vs 49.9 ± 15.4 ml/cmH 2 O, p = 0.03). The Compliance-matched-ARDS and COVID-19-ARDS had similar Crs (50.1 ± 15.7 and 49.9 ± 15.4 ml/cmH 2 O, respectively) but significantly lower PaO 2 /FiO 2 for the same Crs (160 ± 62 vs 106.5 ± 59.6 mmHg, p < 0.001). The three populations had similar lung weights but COVID-19-ARDS had significantly higher lung gas volume (PaO 2 /FiO 2-matched-ARDS 930 ± 644 ml, COVID-19-ARDS 1670 ± 791 ml and Compliance-matched-ARDS 1301 ± 627 ml, p < 0.05). The venous admixture was significantly related to the non-aerated tissue in PaO 2 /FiO 2-matched-ARDS and Compliance-matched-ARDS (p < 0.001) but unrelated in COVID-19-ARDS (p = 0.75), suggesting that hypoxemia was not only due to the extent of non-aerated tissue. Increasing PEEP from 5 to 15 cmH 2 O improved oxygenation in all groups. However, while lung mechanics and dead space improved in PaO 2 /FiO 2-matched-ARDS, suggesting recruitment as primary mechanism, they remained unmodified or worsened in COVID-19-ARDS and Compliance-matched-ARDS, suggesting lower recruitment potential and/or blood flow redistribution. Conclusions: COVID-19-ARDS is a subset of ARDS characterized overall by higher compliance and lung gas volume for a given PaO 2 /FiO 2 , at least when considered within the timeframe of our study.

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“…Therefore, it was not possible to use this population as control. Given the unusual duration of mechanical ventilation in COVID-19 patients, [12] we compared them to patients obtained from a preexisting subarachnoid hemorrhage (SAH) institutional database cohort. [13] These patients were admitted to our ICU from January 2016 -2019.…”

Section: Controlsmentioning

confidence: 99%

The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

Bogossian

Taccone

Izzi

et al. 2020

Preprint

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Background: Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.Methods: This single center case control study included adult patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage (SAH) and matched on length of ICU stay using a competing risk analysis.Results: Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).Conclusion: Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.

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Respiratory Mechanics and Gas Exchange in COVID-19–associated Respiratory Failure

Cited by 118 publications

References 12 publications

Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

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

The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

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