Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus Disease 2019: A Multicenter Cohort Study.

We conducted a multicenter cohort study to determine the effect of drug therapies on survival in mechanically ventilated patients with coronavirus disease 2019. All consecutive adult patients admitted to ICU for coronavirus disease 2019 from March 1, 2020, to April 25, 2020, and under invasive mechanical ventilation for more than 24 hours were included. Out of 2,003 patients hospitalized for coronavirus disease 2019, 361 were admitted to ICU, 257 were ventilated for more than 24 hours, and 247 were included in the study. Simple and multiple time-dependent Cox regression models were used to assess the effects of factors on survival. Methylprednisolone administration during the first week of mechanical ventilation was associated with a decrease in mortality rate from 48% to 34% (p = 0.01). Mortality was significantly associated with older age, higher creatinine, lower lymphocyte count, and mean arterial pressure lower than 70 mm Hg on the day of admission.

Hemodynamics in the pulmonary artery of a patient with pneumothorax.

Pneumothorax is characterized by lung collapse and an alteration of lung geometry, resulting in alterations of the pulmonary artery blood flow. Though many clinical studies and animal experiments have investigated the effects of pneumothorax on the hemodynamics of pulmonary arteries, its precise effects remain unclear. In this patient-specific study, we investigated the effects of lung deformation and vascular resistance increases due to pneumothorax on the pulmonary blood flow during the acute phase and after recovery. Arterial geometry was extracted up to the fifth generation from computed tomography images, and reconstructed. Computational fluid dynamic analysis was performed, for an unsteady laminar flow with resistance at the outlets, in a reconstructed domain. The results demonstrated a change in flow structure during systole between the acute phase and recovery, and were associated with variations in the flow rate ratio between the right and left lungs. We observed a parabolic-like decrease of the volume flow rate ratio in the affected lung as the resistance increased. Thus, the systemic artery blood oxygenation will rely more on the unaffected lung leading to improved oxygenation of the blood under high resistance in the affected lung. These findings are significant in our understanding of ventilation function under a pneumothorax.