Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies
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RESEARCH
Open Access
Respiratory physiology of COVID-19induced respiratory failure compared to ARDS of other etiologies Domenico Luca Grieco1,2* , Filippo Bongiovanni1,2, Lu Chen3,4, Luca S. Menga1,2, Salvatore Lucio Cutuli1,2, Gabriele Pintaudi1,2, Simone Carelli1,2, Teresa Michi1,2, Flava Torrini1,2, Gianmarco Lombardi1,2, Gian Marco Anzellotti1,2, Gennaro De Pascale1,2, Andrea Urbani5,6, Maria Grazia Bocci1,2, Eloisa S. Tanzarella1,2, Giuseppe Bello1,2, Antonio M. Dell’Anna1,2, Salvatore M. Maggiore7, Laurent Brochard3,4 and Massimo Antonelli1,2
Abstract Background: Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes. Methods: Thirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24 h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5 cmH2O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO2/FiO2, FiO2, PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study. Results: Thirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th–75th percentiles] PaO2/FiO2 in the two groups was 119 mmHg [101–142] and 116 mmHg [87–154]. Average compliance (41 ml/cmH2O [32–52] vs. 36 ml/cmH2O [27–42], p = 0.045) and ventilatory ratio (2.1 [1.7–2.3] vs. 1.6 [1.4–2.1], p = 0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO2/FiO2 was linearly correlated with respiratory system compliance (r = 0.52 p = 0.003). High PEEP improved PaO2/FiO2 in both cohorts, but more remarkably in COVID-19 patients (p = 0.005). Recruitability was not different between cohorts (p = 0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP. (Continued on next page)
* Correspondence: [email protected] 1 Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 2 Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International Lice
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