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Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS

2021; BioMed Central; Volume: 25; Issue: 1 Linguagem: Inglês

10.1186/s13054-021-03667-6

1466-609X

Annalisa Boscolo, Nicolò Sella, Giulia Lorenzoni, Tommaso Pettenuzzo, Laura Pasin, Chiara Pretto, Martina Tocco, Enrico Tamburini, Alessandro De Cassai, Paolo Rosi, Enrico Polati, Katia Donadello, Leonardo Gottin, Silvia De Rosa, Fabio Baratto, Fabio Toffoletto, V. Marco Ranieri, Darío Gregori, Paolo Navalesi, Ilaria Valeri, Giulio Andreatta, Leonardo Gandolfi, Alessandra Gadaldi, Nicolò Brumana, Edoardo Forin, Christelle Correale, Elisa Pesenti, Davide Fregolent, Pier Francesco Pirelli, Davide Marchesin, Matteo Perona, Nicola Franchetti, Michele Della Paolera, Caterina Simoni, Tatiana Falcioni, Alessandra Tresin, Chiara Schiavolin, Aldo Schiavi, Sonila Vathi, Daria Sartori, Alice Sorgato, Elisa Pistollato, Federico Linassi, Eugenio Serra, Demetrio Pittarello, Ivo Tiberio, Ottavia Bond, Elisa Michieletto, Luisa Muraro, Arianna Peralta, Paolo Persona, Enrico Petranzan, Francesco Zarantonello, Alessandro Di Graziano, E. Piasentini, L. Bernardi, Roberto Pianon, Flavio Badii, Enrico Bosco, Moreno Agostini, Antonio Farnia, Mario Peta, Mauro Antonio Calò, Marco Meggiolaro, Francesco Lazzari, Ivan Martinello, Giorgio Fullin, Francesco Papaccio, Alfeo Bonato, Camilla Sgarabotto, Francesco Montacciani, Parnigotto Alessandra, G. Gagliardi, Gioconda Ferraro, Luigi Ongaro, Marco Baiocchi, Vinicio Danzi, Paolo Zanatta, Simonetta Marchiotto, Silvia Bassanini, Massimo Zamperini, Ivan Daroui,

Long-Term Effects of COVID-19

Abstract Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th–April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality ( p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH 2 O; (2) the association between DP and ICU mortality was linear ( p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH 2 O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06–1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55–1.52). Multivariable analysis confirmed these findings. Conclusions Crs < 48 ml/cmH 2 O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.