Characterization of patients with COVID-19-related ARDS before the prone position: prospective cohort study

Abstract

; Bruno Valle Pinheiro 3  Abstract Background : The general characteristics and ventilator-related variables of patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection who have undergone invasive mechanical ventilation (MV) remain unclear, especially those who need a prone position (PP). Aim : To characterize the clinical, demographical, and ventilatory variables of patients on MV with COVID-19-related ARDS, evolving to PP. Methods : This study was an observational prospective cohort investigation of COVID-19 patients undergoing invasive MV. PP and non-prone groups were compared using Student’s t, Mann-Whitney U, chi-square, or Fisher’s exact tests. Binary logistic regression was used to identify predictor variables. Statistical significance was set at p < 0.05. The study design was approved by the Research Ethics Committee. Results : The clinical and demographical characteristics of patients requiring PP were: age (63.4 ± 12.4 years), predicted body weight (57.3 ± 11.0 kg), SAPS 3 47.5 (41-55), SOFA 3 (2-6), comorbidities, days until intubation (1.2 ± 2.2 days), and death in the ICU (52.4%); these characteristics were similar to those who remained in supine position. A total of 42 (65.6%) subjects needed PP, especially females. There were no differences between PP and non-prone groups in respiratory system compliance (C rs ) [(30.0 (24.6-35.3)], driving pressure (ΔP) (14.2 ± 3.9 cm H 2 O) and plateau pressure (Pplateau) (23.9 ± 4.7 cmH 2 O). The PP group had lower initial PaO 2 /FIO 2 ratio values (130.5 ± 58.1 vs 187.5 ± 59.1, p < 0,05). C rs was not a significant predictor of PP (OR 1.702; CI 95% 0.962 – 1.131). Conclusions : Most patients required PP, especially females aged over 60. These patients frequently use neuromuscular blockers and had a longer hospital stay. Upon admission to the ICU, the C rs , Pplateau, and ΔP values of these patients were similar to those who did not require PP; PaO 2 /FiO 2 Respiratory Distress Syndrome. How can the results this on the day of orotracheal intubation. The prognostic system used was the Simplified Acute Physiology Score 3 (SAPS 3), to establish a predictive index of mortality for patients admitted to intensive care units. Coexisting medical conditions were obtained from the patients’ medical records and clinical history. These were used to calculate the Charlson Comorbidity Index (Charlson Index). Instrumental score calculations were performed by the physician responsible for the ICU stay duration and added to the study’s database, along with information on the following laboratory tests of interest: C-reactive protein (mg/l), leukocytes (103/mm 3 ), lymphocytes (103/mm 3 ), lactate (U/l), creatine phosphokinase (U/l), lactate dehydrogenase (IU/l), D-dimer and ferritin (mcg/l) levels.