Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS
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ORIGINAL
Clinical features, ventilatory management, and outcome of ARDS caused by COVID‑19 are similar to other causes of ARDS Carlos Ferrando1,2* , Fernando Suarez‑Sipmann2,3,4, Ricard Mellado‑Artigas1, María Hernández5, Alfredo Gea6, Egoitz Arruti7, César Aldecoa8, Graciela Martínez‑Pallí1, Miguel A. Martínez‑González9,10, Arthur S. Slutsky11,12 and Jesús Villar2,11,13on behalf of the COVID-19 Spanish ICU Network © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adher‑ ence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of con‑ firmed 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 driv‑ ing pressure 12 (10–16) cmH2O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruit‑ ment 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. Keywords: Acute respiratory distress syndrome, Coronavirus, Mechanical ventilation, Outcome
*Correspondence: [email protected] 1 Department of Anesthesiology and Critical Care, Institut D’investigació August Pi I Sunyer, Hospital Clínic, Villarroel 170, 08025 Barcelona, Spain Full author information is available at the end of the article
Members of the COVID-19 Spanish ICU Network are listed in the Acknowledgements section.
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