An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients.
In: Critical care (London, England), Jg. 25 (2021-06-09), Heft 1, S. 199
Online
academicJournal
Zugriff:
Background: Heterogeneous respiratory system static compliance (C RS ) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.
Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe C RS -calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]-and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.
Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of C RS within the first seven days of MV. Median (IQR) age was 62 (52-71), patients were predominantly males (68%) and from Europe/North and South America (88%). C RS , within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO 2 /FiO 2 (p = 0.100). Females presented lower C RS than males (95% CI of C RS difference between females-males: - 11.8 to - 7.4 mL/cmH 2 O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with C RS was marginal (p = 0.139). Ventilatory management varied across C RS range, resulting in a significant association between C RS and driving pressure (estimated decrease - 0.31 cmH 2 O/L per mL/cmH 2 0 of C RS , 95% CI - 0.48 to - 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that C RS (+ 10 mL/cm H 2 O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02-1.28, p = 0.018).
Conclusions: This multicentre report provides a comprehensive account of C RS in COVID-19 patients on MV. C RS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study .
Trial Registration: ACTRN12620000421932.
| Titel: |
An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients.
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| Autor/in / Beteiligte Person: | Li Bassi, G ; Suen, JY ; Dalton, HJ ; White, N ; Shrapnel, S ; Fanning, JP ; Liquet, B ; Hinton, S ; Vuorinen, A ; Booth, G ; Millar, JE ; Forsyth, S ; Panigada, M ; Laffey, J ; Brodie, D ; Fan, E ; Torres, A ; Chiumello, D ; Corley, A ; Elhazmi, A ; Hodgson, C ; Ichiba, S ; Luna, C ; Murthy, S ; Nichol, A ; Ng, PY ; Ogino, M ; Pesenti, A ; Trieu, HT ; Fraser, JF |
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| Zeitschrift: | Critical care (London, England), Jg. 25 (2021-06-09), Heft 1, S. 199 |
| Veröffentlichung: | London, UK : BioMed Central Ltd ; <i>Original Publication</i>: London : Current Science Ltd, c1997-, 2021 |
| Medientyp: | academicJournal |
| ISSN: | 1466-609X (electronic) |
| DOI: | 10.1186/s13054-021-03518-4 |
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