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Comparing Clinical Features and Outcomes in Mechanically Ventilated Patients with COVID-19 and Acute Respiratory Distress Syndrome.
Sjoding, Michael W; Admon, Andrew J; Saha, Anjan K; Kay, Stephen G; Brown, Christopher A; Co, Ivan; Claar, Dru; McSparron, Jakob I; Dickson, Robert P.
  • Sjoding MW; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
  • Admon AJ; Department of Computational Medicine and Bioinformatics, and.
  • Saha AK; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan.
  • Kay SG; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and.
  • Brown CA; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
  • Co I; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and.
  • Claar D; Division of Infectious Diseases, Department of Internal Medicine.
  • McSparron JI; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
  • Dickson RP; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
Ann Am Thorac Soc ; 18(11): 1876-1885, 2021 11.
Article in English | MEDLINE | ID: covidwho-1084007
Semantic information from SemMedBD (by NLM)
1. Respiratory Distress Syndrom PROCESS_OF C0030705
Subject
Respiratory Distress Syndrom
Predicate
PROCESS_OF
Object
C0030705
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
Subject
Respiratory Distress Syndrome, Adult
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
Rationale Patients with severe coronavirus disease (COVID-19) meet clinical criteria for the acute respiratory distress syndrome (ARDS), yet early reports suggested they differ physiologically and clinically from patients with non-COVID-19 ARDS, prompting treatment recommendations that deviate from standard evidence-based practices for ARDS.

Objectives:

To compare respiratory physiology, clinical outcomes, and extrapulmonary clinical features of severe COVID-19 with non-COVID-19 ARDS.

Methods:

We performed a retrospective cohort study, comparing 130 consecutive mechanically ventilated patients with severe COVID-19 with 382 consecutive mechanically ventilated patients with non-COVID-19 ARDS. Initial respiratory physiology and 28-day outcomes were compared. Extrapulmonary manifestations (inflammation, extrapulmonary organ injury, and coagulation) were compared in an exploratory analysis.

Results:

Comparison of patients with COVID-19 and non-COVID-19 ARDS suggested small differences in respiratory compliance, ventilatory efficiency, and oxygenation. The 28-day mortality was 30% in patients with COVID-19 and 38% in patients with non-COVID-19 ARDS. In adjusted analysis, point estimates of differences in time to breathing unassisted at 28 days (adjusted subdistributional hazards ratio, 0.98 [95% confidence interval (CI), 0.77-1.26]) and 28-day mortality (risk ratio, 1.01 [95% CI, 0.72-1.42]) were small for COVID-19 versus non-COVID-19 ARDS, although the confidence intervals for these estimates include moderate differences. Patients with COVID-19 had lower neutrophil counts but did not differ in lymphocyte count or other measures of systemic inflammation.

Conclusions:

In this single-center cohort, we found no evidence for large differences between COVID-19 and non-COVID-19 ARDS. Many key clinical features of severe COVID-19 were similar to those of non-COVID-19 ARDS, including respiratory physiology and clinical outcomes, although our sample size precludes definitive conclusions. Further studies are needed to define COVID-19-specific pathophysiology before a deviation from evidence-based treatment practices can be recommended.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Ann Am Thorac Soc Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Ann Am Thorac Soc Year: 2021 Document Type: Article