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Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

BACKGROUND: Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP)...

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Detalles Bibliográficos
Autores principales: Grieco, Domenico Luca, Bongiovanni, Filippo, Chen, Lu, Menga, Luca S., Cutuli, Salvatore Lucio, Pintaudi, Gabriele, Carelli, Simone, Michi, Teresa, Torrini, Flava, Lombardi, Gianmarco, Anzellotti, Gian Marco, De Pascale, Gennaro, Urbani, Andrea, Bocci, Maria Grazia, Tanzarella, Eloisa S., Bello, Giuseppe, Dell’Anna, Antonio M., Maggiore, Salvatore M., Brochard, Laurent, Antonelli, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453378/
https://www.ncbi.nlm.nih.gov/pubmed/32859264
http://dx.doi.org/10.1186/s13054-020-03253-2
Descripción
Sumario:BACKGROUND: Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes. METHODS: Thirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24 h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5 cmH(2)O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO(2)/FiO(2), FiO(2), PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study. RESULTS: Thirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th–75th percentiles] PaO(2)/FiO(2) in the two groups was 119 mmHg [101–142] and 116 mmHg [87–154]. Average compliance (41 ml/cmH(2)O [32–52] vs. 36 ml/cmH(2)O [27–42], p = 0.045) and ventilatory ratio (2.1 [1.7–2.3] vs. 1.6 [1.4–2.1], p = 0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO(2)/FiO(2) was linearly correlated with respiratory system compliance (r = 0.52 p = 0.003). High PEEP improved PaO(2)/FiO(2) in both cohorts, but more remarkably in COVID-19 patients (p = 0.005). Recruitability was not different between cohorts (p = 0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP. CONCLUSIONS: Early after establishment of mechanical ventilation, COVID-19 patients follow ARDS physiology, with compliance reduction related to the degree of hypoxemia, and inter-individually variable respiratory mechanics and recruitability. Physiological differences between ARDS from COVID-19 and other causes appear small.