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

Abstract

PURPOSE:

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) cmH2O. Values of respiratory system compliance 35 (27-45) ml/cmH2O, plateau pressure 25 (22-29) cmH2O, and driving pressure 12 (10-16) cmH2O 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.

• Authors: Carlos Ferrando, Fernando Suarez-Sipmann, Ricard Mellado-Artigas, María Hernández, Alfredo Gea, Egoitz Arruti, César Aldecoa, Graciela Martínez-Pallí, Miguel A Martínez-González, Arthur S Slutsky, Jesús Villar, COVID-19 Spanish ICU Network
• Journal: Intensive care medicine (Intensive Care Med) Vol. 46 Issue 12 Pg. 2200-2211 (12 2020) ISSN: 1432-1238 [Electronic] United States
• PMID: 32728965 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Analysis of Variance
• COVID-19 (physiopathology, therapy)
• Correlation of Data
• Female
• Humans
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Respiration, Artificial (methods)
• Respiratory Distress Syndrome (physiopathology, therapy)
• Severity of Illness Index
• Spain
• Statistics, Nonparametric