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An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients.
Li Bassi, Gianluigi; Suen, Jacky Y; Dalton, Heidi J; White, Nicole; Shrapnel, Sally; Fanning, Jonathon P; Liquet, Benoit; Hinton, Samuel; Vuorinen, Aapeli; Booth, Gareth; Millar, Jonathan E; Forsyth, Simon; Panigada, Mauro; Laffey, John; Brodie, Daniel; Fan, Eddy; Torres, Antoni; Chiumello, Davide; Corley, Amanda; Elhazmi, Alyaa; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Murthy, Srinivas; Nichol, Alistair; Ng, Pauline Yeung; Ogino, Mark; Pesenti, Antonio; Trieu, Huynh Trung; Fraser, John F.
  • Li Bassi G; Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia. g.libassi@uq.edu.au.
  • Suen JY; University of Queensland, Brisbane, Australia. g.libassi@uq.edu.au.
  • Dalton HJ; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. g.libassi@uq.edu.au.
  • White N; Queensland University of Technology, Brisbane, Australia. g.libassi@uq.edu.au.
  • Shrapnel S; St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia. g.libassi@uq.edu.au.
  • Fanning JP; Wesley Medical Research, Brisbane, Australia. g.libassi@uq.edu.au.
  • Liquet B; Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia.
  • Hinton S; University of Queensland, Brisbane, Australia.
  • Vuorinen A; INOVA Fairfax Medical Center, Heart and Vascular Institute, Falls Church, VA, USA.
  • Booth G; Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
  • Millar JE; University of Queensland, Brisbane, Australia.
  • Forsyth S; Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia.
  • Panigada M; University of Queensland, Brisbane, Australia.
  • Laffey J; Wesley Medical Research, Brisbane, Australia.
  • Brodie D; University of Queensland, Brisbane, Australia.
  • Fan E; University of Pau et Pays De L'Adour, LMAP, E2S-UPPA, CNRS, Pau, France.
  • Torres A; Macquarie University, Sydney, Australia.
  • Chiumello D; University of Queensland, Brisbane, Australia.
  • Corley A; University of Queensland, Brisbane, Australia.
  • Elhazmi A; University of Queensland, Brisbane, Australia.
  • Hodgson C; Roslin Institute, University of Edinburgh, Edinburgh, UK.
  • Ichiba S; Queen Elizabeth II University Hospital, Glasgow, UK.
  • Luna C; University of Queensland, Brisbane, Australia.
  • Murthy S; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Nichol A; Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland.
  • Ng PY; Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital, New York, NY, USA.
  • Ogino M; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
  • Pesenti A; Department of Medicine, University of Toronto, Toronto, Canada.
  • Trieu HT; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
  • Fraser JF; Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada.
Crit Care ; 25(1): 199, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-1262513
ABSTRACT

BACKGROUND:

Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.

METHODS:

We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS-calculated as tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]-and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.

RESULTS:

We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52-71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males - 11.8 to - 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease - 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI - 0.48 to - 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02-1.28, p = 0.018).

CONCLUSIONS:

This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation Available at https//www.covid-critical.com/study . TRIAL REGISTRATION ACTRN12620000421932.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Respiratory Distress Syndrome / Lung Compliance / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03518-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Respiratory Distress Syndrome / Lung Compliance / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03518-4