Hourly Analysis of Mechanical Ventilation Parameters in Critically Ill Adult Covid-19 Patients: Association with Mortality

Objective: there exists controversy about the pathophysiology and lung mechanics of COVID-19 associated ARDS, because some report severe hypoxemia with preserved respiratory system mechanics, contrasting with “classic” ARDS. We performed a detailed hourly analysis of the characteristics and time course of lung mechanics and biochemical analysis of patients requiring invasive mechanical ventilation for COVID-19-associated ARDS, comparing survivors and non-survivors.Methods and measurements: retrospective analysis of the data stored in the ICU information system of patients admitted in our hospital ICU that required invasive mechanical ventilation due to confirmed SARS-CoV-2 pneumonia between March 5th and April 30th, 2020. We compare respiratory system mechanics and gas exchange during the first ten days of IMV, discriminating volume and pressure controlled modes, between ICU survivors and non-survivors.Results: 140 patients were analyzed, analyzing 11,138 respiratory mechanics recordings. Global mortality was 38.6%. Multivariate analysis showed that age (OR 1,092, 95% (CI 1,014-1,176)), previous use of ACEI/ARBs (OR 4,612, (95% CI 1,19-17,84)) and need of renal replacement therapies (OR 10,15, (95% CI 1,58-65,11)) were associated with higher mortality. Respiratory variables start to diverge significantly between survivors and non-survivors after the 96 to 120 hours from mechanical ventilation initiation, particularly respiratory system compliance. In non survivors, mechanical power at 24 and 96 hs was higher regardless ventilatory mode. Conclusions: in patients admitted for SARS-CoV-2 pneumonia and requiring mechanical ventilation, non survivors have different respiratory system mechanics than survivors in the first 10 days of ICU admission. We propose a checkpoint at 96-120 hs to assess patients` improvement or worsening in order to consider escalating to extracorporeal therapies.“TAKE HOME MESSAGE”: assessing respiratory mechanics in the first 96-120 hs from ICU admission could predict the outcome of Covid-19 patients under mechanical ventilation.