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COVID-19 ARDS Is Characterized by Increased Dead Space Ventilation Compared With Non-COVID ARDS.
Bertelli, Michele; Fusina, Federica; Prezioso, Chiara; Cavallo, Erika; Nencini, Niccolò; Crisci, Serena; Tansini, Francesca; Mari, Letizia Mazzuca; Hoxha, Laureta; Lombardi, Fabiana; Natalini, Giuseppe.
  • Bertelli M; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Fusina F; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy. f.fusina@gmail.com.
  • Prezioso C; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Cavallo E; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
  • Nencini N; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Crisci S; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
  • Tansini F; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Mari LM; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
  • Hoxha L; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Lombardi F; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
  • Natalini G; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
Respir Care ; 66(9): 1406-1415, 2021 09.
Article in English | MEDLINE | ID: covidwho-1244287
ABSTRACT

BACKGROUND:

ARDS in patients with coronavirus disease 2019 (COVID-19) is characterized by microcirculatory alterations in the pulmonary vascular bed, which could increase dead-space ventilation more than in non-COVID-19 ARDS. We aimed to establish if dead-space ventilation is different in patients with COVID-19 ARDS when compared with patients with non-COVID-19 ARDS.

METHODS:

A total of 187 subjects with COVID-19 ARDS and 178 subjects with non-COVID-19 ARDS who were undergoing invasive mechanical ventilation were included in the study. The association between the ARDS types and dead-space ventilation, compliance of the respiratory system, subjects' characteristics, organ failures, and mechanical ventilation was evaluated by using data collected in the first 24 h of mechanical ventilation.

RESULTS:

Corrected minute ventilation (V˙E), a dead-space ventilation surrogate, was higher in the subjects with COVID-19 ARDS versus in those with non-COVID-19 ARDS (median [interquartile range] 12.6 [10.2-15.8] L/min vs 9.4 [7.5-11.6] L/min; P < .001). Increased corrected V˙E was independently associated with COVID-19 ARDS (odds ratio 1.24, 95% CI 1.07-1.47; P = .007). The best compliance of the respiratory system, obtained after testing different PEEPs, was similar between the subjects with COVID-19 ARDS and the subjects with non-COVID-19 ARDS (mean ± SD 38 ± 11 mL/cm H2O vs 37 ± 11 mL/cm H2O, respectively; P = .61). The subjects with COVID-19 ARDS received higher median (interquartile range) PEEP (12 [10-14] cm H2O vs 8 [5-9] cm H2O; P < .001) and lower median (interquartile range) tidal volume (5.8 [5.5-6.3] mL/kg vs 6.6 [6.1-7.3] mL/kg; P < .001) than the subjects with non-COVID-19 ARDS, being these differences maintained at multivariable analysis. In the multivariable analysis, the subjects with COVID-19 ARDS showed a lower risk of anamnestic arterial hypertension (odds ratio 0.18, 95% CI 0.07-0.45; P < .001) and lower neurologic sequential organ failure assessment score (odds ratio 0.16, 95% CI 0.09-0.27; P < .001) than the subjects with non-COVID-19 ARDS.

CONCLUSIONS:

Indirect measurements of dead space were higher in subjects with COVID-19 ARDS compared with subjects with non-COVID-19 ARDS. The best compliance of the respiratory system was similar in both ARDS forms provided that different PEEPs were applied. A wide range of compliance is present in every ARDS type; therefore, the setting of mechanical ventilation should be individualized patient by patient and not based on the etiology of ARDS.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Etiology study / Experimental Studies / Prognostic study Limits: Humans Language: English Journal: Respir Care Year: 2021 Document Type: Article Affiliation country: Respcare.08786

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Etiology study / Experimental Studies / Prognostic study Limits: Humans Language: English Journal: Respir Care Year: 2021 Document Type: Article Affiliation country: Respcare.08786