Respiratory Mechanics of COVID-19– versus Non–COVID-19–associated Acute Respiratory Distress Syndrome

Haudebourg, Anne-Fleur; Perier, François; Tuffet, Samuel; Prost, Nicolas de; Razazi, Keyvan; Dessap, Armand Mekontso; Carteaux, Guillaume

doi:10.1164/rccm.202004-1226le

Cited by 138 publications

(174 citation statements)

References 11 publications

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“…Our second key finding was that the potential for lung recruitment appears to be maintained in COVID-19 ARDS, because the effects of LRMs or prone positioning are similar to those observed in non–COVID-19 ARDS. Our results are in line with recent publications ( 6 – 8 ). Pan and colleagues evaluated the potential for lung recruitment (as the recruitment-to-inflation ratio) in COVID-19 ARDS.…”

Section: Discussionsupporting

confidence: 94%

“…Overall, the median (IQR) respiratory system compliance was 30 (23–40) ml/cm H 2 O; the two groups did not differ significantly in this respect. This value is close to those reported in the literature for COVID-19 and non–COVID-19 ARDS ( 3 – 6 ). Our results go against the assumptions initially made by many clinicians (ourselves included) whereby lung mechanics in COVID-19 ARDS are relatively unaffected but gas exchanges are more severely impaired than in non–COVID-19 ARDS ( 1 ).…”

Section: Discussionsupporting

confidence: 90%

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COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

Brault

Zerbib

Kontar

et al. 2020

Am J Respir Crit Care Med

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 90%

COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

Brault

Zerbib

Kontar

et al. 2020

Am J Respir Crit Care Med

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“…We failed to show any differences in mortality between mechanically ventilated versus non-mechanically ventilated patients [ 3 , 4 , 7 , 8 ] but our retrospective study was significantly underpowered. However, subgroup analysis revealed higher body mass index and rate of nosocomial acquired infections in the COVID-19 mechanically ventilated subgroup of patients versus the non-mechanically ventilated group, which is in accordance with previous reports [ [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ]. In our study, the incidence of nosocomial acquired infections based on strict clinical criteria was 19.6%, which although an important cofactor did not affect mortality during TCZ therapy.…”

Section: Discussionsupporting

confidence: 92%

Tocilizumab in the treatment of rapidly evolving COVID-19 pneumonia and multifaceted critical illness: A retrospective case series

Mady

Aletreby

Abdulrahman

et al. 2020

Annals of Medicine and Surgery

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Background COVID-19 associated critical illness characterized by rapidly evolving acute respiratory failure (ARF) can develop, especially on the grounds of hyperinflammation. Aim and methods A case-series of 61 patients admitted to our intensive care unit (ICU) between August 12 and September 12, 2020 with confirmed COVID-19 pneumonia and rapidly evolving ARF requiring oxygen support therapy and/or mechanical ventilation was retrospectively analyzed. We examined whether intravenous administration of tocilizumab, a monoclonal interleukin-6 receptor antibody, was associated with improved outcome. All patients received empiric antivirals, dexamethasone 6 mg/day for 7 days, antibiotics, and prophylactic anticoagulation. Tocilizumab was administered at a dosage of 8 mg/kg [two consecutive intravenous infusions 12 h apart]. Outcome measures such as mortality on day-14, ICU length of stay, and rate of nosocomial acquired bacterial infections were also analyzed. Results: Patients were males (88.2%) aged 51 [interquartile range (IQR): 42.5–58.75)], with admission Acute Physiology and Chronic Health Evaluation (APACHE) 4 score of 53 (IQR: 37.75–72.5), and had more than one comorbidity (62.3%). On admission, twenty nine patients (47.5%) were mechanically ventilated, and thirty two patients (52.5%) were receiving oxygen therapy. No serious adverse effects due to tocilizumab therapy were recorded. However, twelve patients (19.6%) developed nosocomial acquired infections. ICU length of stay was 13 (IQR: 9–17) days, and mortality on day-14 was 24.6%. Six patients were shifted to other hospitals but were followed-up. The overall mortality on day-30 was 31.1%. Non-mechanically ventilated patients had higher survival rates compared to mechanically ventilated patients although results were not significant [hazards ratio = 2.6 (95% confidence intervals: 0.9–7.7), p = 0.08]. Tocilizumab did not affect the mortality of critically ill COVID-19 patients. Conclusion Tocilizumab could be an adjunct safe therapy in rapidly evolving COVID-19 pneumonia and associated critical illness.

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“…So haben bereits Arbeiten der letzten Jahre gezeigt, dass bei ARDS-Patienten eine Individualisierung der Beatmung über eine Phänotypisierung des klinisch sehr heterogenen ARDS-Kollektivs, mortalitätsrelevante Vorteile ergeben kann [23,24]. Auch scheint die Einteilung der beatmeten COVID-19-Patienten in einen L-und H-Typ meist nicht zu gelingen [25][26][27][28][29][30]. Die Individualisierung der Beatmung kann im Wesentlichen über eine Anpassung von TV und PEEP erfolgen (.…”

Section: Sauerstofftherapieunclassified

Behandlungsempfehlungen zur Beatmung von COVID‑19-Patienten

2020

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Behandlungsempfehlungen zur Beatmung von COVID-19-Patienten Die durch SARS-CoV-2 ausgelöste pulmonale COVID-19-Erkrankung zeigt bei schwereren Verläufen eine ausgeprägte Oxygenierungsstörung, die häufig Beatmungspflichtigkeit nach sich zieht. Evidenzbasierte Empfehlungen fehlen aufgrund der Neuartigkeit der Erkrankung [1]. Dieser Beitrag soll einen Weg zur individualisierten Beatmungstherapie dieser Patienten aufzeigen.

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Respiratory Mechanics of COVID-19– versus Non–COVID-19–associated Acute Respiratory Distress Syndrome

Cited by 138 publications

References 11 publications

COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

COVID-19– versus non–COVID-19–related Acute Respiratory Distress Syndrome: Differences and Similarities

Tocilizumab in the treatment of rapidly evolving COVID-19 pneumonia and multifaceted critical illness: A retrospective case series

Behandlungsempfehlungen zur Beatmung von COVID‑19-Patienten

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