1. Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS
- Author
-
Boscolo, A., Sella, N., Lorenzoni, G., Pasin, L., Pretto, C., Tocco, M., Tamburini, E., De Cassai, A., Rosi, P., Polati, E., Donadello, K., Gottin, L., De Rosa, S., Baratto, F., Toffoletto, F., Ranieri, V. M., Gregori, D., Navalesi, P., Valeri, I., Andreatta, G., Gandolfi, L., Gadaldi, A., Brumana, N., Forin, E., Correale, C., Pesenti, E., Fregolent, D., Pirelli, P. F., Marchesin, D., Perona, M., Franchetti, N., Della Paolera, M., Simoni, C., Falcioni, T., Tresin, A., Schiavolin, C., Schiavi, A., Vathi, S., Sartori, D., Sorgato, A., Pistollato, E., Serra, E., Pittarello, D., Tiberio, I., Bond, O., Michieletto, E., Muraro, L., Peralta, A., Persona, P., Petranzan, E., Zarantonello, F., Graziano, A., Piasentini, E., Bernardi, L., Pianon, R., Badii, F., Bosco, E., Agostini, M., Farnia, A., Peta, M., Calo, M. A., Meggiolaro, M., Lazzari, F., Martinello, I., Fullin, G., Papaccio, F., Bonato, A., Sgarabotto, C., Montacciani, F., Alessandra, P., Gagliardi, G., Ferraro, G., Ongaro, L., Baiocchi, M., Danzi, V., Zanatta, P., Marchiotto, S., Bassanini, S., Zamperini, M., Daroui, I., Linassi, F., and Pettenuzzo, T.
- Subjects
Male ,ARDS ,Supine position ,COVID-19 ,Driving pressure ,Mechanical ventilation ,Respiratory system compliance ,medicine.medical_treatment ,Pulmonary compliance ,Critical Care and Intensive Care Medicine ,Hypoxemia ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Tidal Volume ,Humans ,Medicine ,Tidal volume ,Aged ,Respiratory Distress Syndrome ,RC86-88.9 ,business.industry ,Respiration ,Research ,Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Intensive care unit ,Intensive Care Units ,Female ,Intubation ,Italy ,030228 respiratory system ,Anesthesia ,Artificial ,medicine.symptom ,business ,Cohort study - Abstract
Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th–April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values 2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06–1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55–1.52). Multivariable analysis confirmed these findings. Conclusions Crs 2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.
- Published
- 2021
- Full Text
- View/download PDF