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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)...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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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 |
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author | 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 |
author_facet | 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 |
author_sort | Grieco, Domenico Luca |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7453378 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74533782020-08-28 Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies 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 Crit Care Research 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. BioMed Central 2020-08-28 /pmc/articles/PMC7453378/ /pubmed/32859264 http://dx.doi.org/10.1186/s13054-020-03253-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research 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 Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title | Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title_full | Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title_fullStr | Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title_full_unstemmed | Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title_short | Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies |
title_sort | respiratory physiology of covid-19-induced respiratory failure compared to ards of other etiologies |
topic | Research |
url | 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 |
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