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The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

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

10.1186/s13054-021-03727-x

1466-609X

Antoni Torres, Ana Motos, Jordi Riera, Laia Fernández‐Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Óscar Peñuelas, José Ángel Lorente, Alejandro Rodríguez, David de Gonzalo‐Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martín, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortíz, Elena Bustamante‐Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristobal Galbán‐Malagón, Víctor D. Gumucio-Sanguino, María del Carmen de la Torre, Emili Dı́az, Ángel Estella, Elena Gallego, J.L. García Garmendia, José Garnacho‐Montero, José María Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marín‐Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socías, Jordi Solé‐Violán, Fernando Suárez-Sipmann, Luis Tamayo Lomas, Josep Trenado, Ferrán Barbé, Berta Adell-Serrano, Alexander Agrifoglio, María Aguilar Cabello, Luciano Aguilera, Victoria Alcaraz-Serrano, César Aldecoa, Cynthia Alegre, Sergio Álvarez, Antonjo Álvarez Ruiz, Rut Andrea, José Ángel, Marta Arrieta, Ignacio Ayestarán, Joan R. Badia, Mariona Badía, Orville Báez Pravia, Ana Balan Mariño, Begoña Balsera, Laura Barbena, Enric Barbeta, Tommaso Bardi, Patricia Barral Segade, Marta Barroso, José Ángel Berezo García, Judit Bigas, Rafael Blancas, María Luisa Blasco, María Victoria Boado, María Bodi Saera, Neus Bofill, María Teresa Bouza Vieiro, Leticia Bueno, Juan Bustamante‐Munguira, Lucia Cachafeiro, David Campi Hermoso, Sandra Campos Fernández, Iosune Cano, María Luisa Cantón‐Bulnes, Pablo Cardina Fernández, Laura Carrión García, Sula Carvalho, Núria Casacuberta-Barberà, Manuel Castellá, Andrea Castellví, Pedro Castro, Ramón Cicuéndez Avila, Catia Cillóniz, Luisa Clar, Cristina Climent, Jordi Codina, Pamela Conde, Sofía Contreras, M.C. Martín Delgado, Raúl de Pablo, Diego de Mendoza, Cecilia del Busto Martínez, Yolanda Díaz, María Digna Rivas Vilas, Cristina Moreno, Irene Dot, Pedro Enríquez Giraudo, Inés Esmorís Arijón, Teresa Farre Monjo, Javier Fernández, Carlos Ferrando, Albert Figueras, Eva Forcadell-Ferreres, Lorena Forcelledo Espina, Nieves Franco, Àngels Furro, Felipe García, Beatriz García, Emilio García-Prieto, Carlos García Redruello, Amaia García Sagastume, Maria Luisa Gascón Castillo, Gemma Gomà, Vanesa Gómez Casal, Sílvia Gómez, Carmen Gómez González, Jessica González, Federico Gordo, M.P. Gracia, Alba Herraiz, Rubén Herrán‐Monge, Mercedes Ibarz, Sílvia Iglesias, Maria Teresa Janer, Gabriel Jiménez, Mar Juan Díaz, Karsa Kiarostami, Juan I. Lazo Álvarez, Miguel Leonardo García León, Alexandre López-Gavín, Ana López Lago, Desire Macias Guerrero, Nuria Mamolar Herrera, Rafael Máñez, Cecilia L. Mantellini, Gregorio Marco Naya, Pilar Marcos, Enrique Marmol Peis, Paula Martín Vicente, María Martínez-Martínez, Carmen Eulalia Martínez Fernández, Maria Dolores Martínez Juan, J.F. Masa Jiménez, Joan Ramón Masclans, Emilio Maseda, Eva María Menor Fernández, Mar Miralbés, Josman Monclou, Juan Carlos Montejo, Neus Montserrat, María Mora Aznar, Pedro Moral-Parras, Dulce Morales, Sara Guadalupe Moreno Cano, David Mosquera Rodríguez, Rosana Muñoz-Bermúdez, José M. Nicolás, Ramón Nogué Bou, Rafaela Nogueras Salinas, Marta Ocón, Ana Ortega, Sergio Ossa, Pablo Pagliarani, Anna Pous, F. Gómez, Leire Pérez Bastida, Purificación Pérez, Gloria Pérez Planelles, Eva Pérez Rubio, David Pestaña Laguna, Àngels Piñol-Tena, Javier Prados, Andrés Pujol, Núria Ramon Coll, Gloria Renedo Sánchez‐Girón, Ferran Roche‐Campo, Laura Rodríguez, Felipe Rodrı́guez de Castro, Silvia Rodríguez, Covadonga Rodríguez Ruíz, Jorge Rubio, Alberto Rubio-López, Miriam Ruiz Miralles, Pablo Ryan, Eva Saborido Paz, Ana Salazar Degracia, Miguel Sánchez, Ana Sánchez, Bitor Santacoloma, María Teresa Sariñena, Marta Segura Pensado, Lidia Serra, Mireia Serra-Fortuny, Ainhoa Serrano, Luis Serviá, Laura Soliva, Carla Speziale, Daniel Tognetti, Adrián Tormos, Mateu Torres, Sandra Trefler, Javier Trujillano, Alejandro Úbeda, Luis Urrelo-Cerrón, Estela Val, Luis Valdivia Ruiz, Montserrat Vallverdú, Maria Van der Hofstadt Martin-Montalvo, Sabela Vara Adrio, Nil Vázquez, Javier Vengoechea, Pablo Vidal, C. Vilà, Judit Vilanova, Tatiana Villada Warrington, Hua Yang, Minlan Yang, Ana Zapatero,

Long-Term Effects of COVID-19

Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO 2 /FiO 2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO 2 /FiO 2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO 2 /FiO 2 variation.