Epidemiology, ventilation management and outcomes of COVID-19 ARDS patients versus patients with ARDS due to pneumonia in the Pre-COVID era.

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-08-17 DOI:10.1186/s12931-024-02910-2
Fleur-Stefanie L I M van der Ven, Siebe G Blok, Luciano C Azevedo, Giacomo Bellani, Michela Botta, Elisa Estenssoro, Eddy Fan, Juliana Carvalho Ferreira, John G Laffey, Ignacio Martin-Loeches, Ana Motos, Tai Pham, Oscar Peñuelas, Antonio Pesenti, Luigi Pisani, Ary Serpa Neto, Marcus J Schultz, Antoni Torres, Anissa M Tsonas, Frederique Paulus, David M P van Meenen
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Abstract

Background: Ventilation management may differ between COVID-19 ARDS (COVID-ARDS) patients and patients with pre-COVID ARDS (CLASSIC-ARDS); it is uncertain whether associations of ventilation management with outcomes for CLASSIC-ARDS also exist in COVID-ARDS.

Methods: Individual patient data analysis of COVID-ARDS and CLASSIC-ARDS patients in six observational studies of ventilation, four in the COVID-19 pandemic and two pre-pandemic. Descriptive statistics were used to compare epidemiology and ventilation characteristics. The primary endpoint were key ventilation parameters; other outcomes included mortality and ventilator-free days and alive (VFD-60) at day 60.

Results: This analysis included 6702 COVID-ARDS patients and 1415 CLASSIC-ARDS patients. COVID-ARDS patients received lower median VT (6.6 [6.0 to 7.4] vs 7.3 [6.4 to 8.5] ml/kg PBW; p < 0.001) and higher median PEEP (12.0 [10.0 to 14.0] vs 8.0 [6.0 to 10.0] cm H2O; p < 0.001), at lower median ΔP (13.0 [10.0 to 15.0] vs 16.0 [IQR 12.0 to 20.0] cm H2O; p < 0.001) and higher median Crs (33.5 [26.6 to 42.1] vs 28.1 [21.6 to 38.4] mL/cm H2O; p < 0.001). Following multivariable adjustment, higher ΔP had an independent association with higher 60-day mortality and less VFD-60 in both groups. Higher PEEP had an association with less VFD-60, but only in COVID-ARDS patients.

Conclusions: Our findings show important differences in key ventilation parameters and associations thereof with outcomes between COVID-ARDS and CLASSIC-ARDS.

Trial registration: Clinicaltrials.gov (identifier NCT05650957), December 14, 2022.

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COVID-19 ARDS 患者与前 COVID 时代肺炎所致 ARDS 患者的流行病学、通气管理和预后对比。
背景:COVID-19 ARDS(COVID-ARDS)患者和COVID前ARDS(CLASSIC-ARDS)患者的通气管理可能不同;目前尚不确定COVID-ARDS患者的通气管理是否与CLASSIC-ARDS的预后相关:方法:对六项通气观察研究中的 COVID-ARDS 和 CLASSIC-ARDS 患者进行个体数据分析,其中四项研究是在 COVID-19 大流行期间进行的,两项研究是在大流行之前进行的。描述性统计用于比较流行病学和通气特征。主要终点是关键通气参数;其他结果包括死亡率和无呼吸机天数以及第 60 天的存活率(VFD-60):该分析包括 6702 名 COVID-ARDS 患者和 1415 名 CLASSIC-ARDS 患者。COVID-ARDS 患者接受的 VT 中位数较低(6.6 [6.0 至 7.4] vs 7.3 [6.4 至 8.5] ml/kg PBW;p 2O;p 2O;p 2O;p 2O;p 结论:我们的研究结果表明,COVID-ARDS 患者和 CLASSIC-ARDS 患者接受的 VT 中位数存在重要差异:我们的研究结果表明,COVID-ARDS和CLASSIC-ARDS的主要通气参数及其与预后的关系存在重大差异:试验注册:Clinicaltrials.gov(标识符 NCT05650957),2022 年 12 月 14 日。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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