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Associations of Body Mass Index with Ventilation Management and Clinical Outcomes in Invasively Ventilated Patients with ARDS Related to COVID-19-Insights from the PRoVENT-COVID Study.
Schavemaker, Renée; Schultz, Marcus J; Lagrand, Wim K; van Slobbe-Bijlsma, Eline R; Serpa Neto, Ary; Paulus, Frederique.
  • Schavemaker R; Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands.
  • Schultz MJ; Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands.
  • Lagrand WK; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand.
  • van Slobbe-Bijlsma ER; Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK.
  • Serpa Neto A; Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands.
  • Paulus F; Department of Intensive Care, Tergooi Hospitals, 1213 XZ Hilversum, The Netherlands.
J Clin Med ; 10(6)2021 03 11.
Article in English | MEDLINE | ID: covidwho-1125931
Semantic information from SemMedBD (by NLM)
1. Body mass index procedure DIAGNOSES Patient ventilated
Subject
Body mass index procedure
Predicate
DIAGNOSES
Object
Patient ventilated
2. Respiratory Distress Syndrom PROCESS_OF C0030705
Subject
Respiratory Distress Syndrom
Predicate
PROCESS_OF
Object
C0030705
3. intensive care unit LOCATION_OF Multicenter Study
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Multicenter Study
4. Obesity PROCESS_OF Patients
Subject
Obesity
Predicate
PROCESS_OF
Object
Patients
5. Positive End-Expiratory Pressure TREATS Obesity
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Obesity
6. Positive End-Expiratory Pressure TREATS Overweight
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Overweight
7. Positive End-Expiratory Pressure TREATS Normal weight
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Normal weight
8. adjunctive treatment TREATS Hypoxemia
Subject
adjunctive treatment
Predicate
TREATS
Object
Hypoxemia
9. Overweight PROCESS_OF Patients
Subject
Overweight
Predicate
PROCESS_OF
Object
Patients
10. Compliance PROCESS_OF Patients
Subject
Compliance
Predicate
PROCESS_OF
Object
Patients
11. Adjuvant Therapy TREATS Hypoxemia
Subject
Adjuvant Therapy
Predicate
TREATS
Object
Hypoxemia
12. Prone positioning TREATS Obesity
Subject
Prone positioning
Predicate
TREATS
Object
Obesity
13. Prone positioning TREATS Overweight
Subject
Prone positioning
Predicate
TREATS
Object
Overweight
14. Prone positioning TREATS Normal weight
Subject
Prone positioning
Predicate
TREATS
Object
Normal weight
15. Respiratory Distress Syndrom COEXISTS_WITH C5203670
Subject
Respiratory Distress Syndrom
Predicate
COEXISTS_WITH
Object
C5203670
16. Body mass index procedure DIAGNOSES Patient ventilated
Subject
Body mass index procedure
Predicate
DIAGNOSES
Object
Patient ventilated
17. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
Subject
Respiratory Distress Syndrome, Adult
Predicate
PROCESS_OF
Object
Patients
18. intensive care unit LOCATION_OF Multicenter Study
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Multicenter Study
19. Obesity PROCESS_OF Patients
Subject
Obesity
Predicate
PROCESS_OF
Object
Patients
20. Positive End-Expiratory Pressure TREATS Obesity
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Obesity
21. Positive End-Expiratory Pressure TREATS Overweight
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Overweight
22. Positive End-Expiratory Pressure TREATS Normal weight
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Normal weight
23. adjunctive treatment TREATS Hypoxemia
Subject
adjunctive treatment
Predicate
TREATS
Object
Hypoxemia
24. Overweight PROCESS_OF Patients
Subject
Overweight
Predicate
PROCESS_OF
Object
Patients
25. Compliance PROCESS_OF Patients
Subject
Compliance
Predicate
PROCESS_OF
Object
Patients
26. Adjuvant Therapy TREATS Hypoxemia
Subject
Adjuvant Therapy
Predicate
TREATS
Object
Hypoxemia
27. Prone positioning TREATS Obesity
Subject
Prone positioning
Predicate
TREATS
Object
Obesity
28. Prone positioning TREATS Overweight
Subject
Prone positioning
Predicate
TREATS
Object
Overweight
29. Prone positioning TREATS Normal weight
Subject
Prone positioning
Predicate
TREATS
Object
Normal weight
30. Respiratory Distress Syndrome, Adult COEXISTS_WITH COVID-19
Subject
Respiratory Distress Syndrome, Adult
Predicate
COEXISTS_WITH
Object
COVID-19
ABSTRACT
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal-weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient's BMI should not be used in decisions to forgo or proceed with invasive ventilation.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: Jcm10061176

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: Jcm10061176