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Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic
Rationale: A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was character...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Thoracic Society
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605177/ https://www.ncbi.nlm.nih.gov/pubmed/32805143 http://dx.doi.org/10.1164/rccm.202005-2046OC |
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author | Panwar, Rakshit Madotto, Fabiana Laffey, John G. |
author_facet | Panwar, Rakshit Madotto, Fabiana Laffey, John G. |
author_sort | Panwar, Rakshit |
collection | PubMed |
description | Rationale: A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was characterized as a distinct ARDS phenotype. Objectives: To determine whether such Crs-based phenotypes existed among patients with ARDS before the COVID-19 pandemic and to closely examine the Crs–mortality relationship. Methods: We undertook a secondary analysis of patients with ARDS, who were invasively ventilated on controlled modes and enrolled in a large, multinational, epidemiological study. We assessed Crs, degree of hypoxemia, and associated Crs-based phenotypic patterns with their characteristics and outcomes. Measurements and Main Results: Among 1,117 patients with ARDS who met inclusion criteria, the median Crs was 30 (interquartile range, 23–40) ml/cm H(2)O. One hundred thirty-six (12%) patients had preserved Crs (≥50 ml/cm H(2)O; phenotype with low elastance [“phenotype L”]), and 827 (74%) patients had poor Crs (<40 ml/cm H(2)O; phenotype with high elastance [“phenotype H”]). Compared with those with phenotype L, patients with phenotype H were sicker and had more comorbidities and higher hospital mortality (32% vs. 45%; P < 0.05). A near complete dissociation between Pa(O(2))/Fi(O(2)) and Crs was observed. Of 136 patients with phenotype L, 58 (43%) had a Pa(O(2))/Fi(O(2)) < 150. In a multivariable-adjusted analysis, the Crs was independently associated with hospital mortality (adjusted odds ratio per ml/cm H(2)O increase, 0.988; 95% confidence interval, 0.979–0.996; P = 0.005). Conclusions: A wide range of Crs was observed in non–COVID-19 ARDS. Approximately one in eight patients had preserved Crs. Pa(O(2))/Fi(O(2)) and Crs were dissociated. Lower Crs was independently associated with higher mortality. The Crs–mortality relationship lacked a clear transition threshold. |
format | Online Article Text |
id | pubmed-7605177 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | American Thoracic Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-76051772020-11-02 Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic Panwar, Rakshit Madotto, Fabiana Laffey, John G. Am J Respir Crit Care Med Original Articles Rationale: A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was characterized as a distinct ARDS phenotype. Objectives: To determine whether such Crs-based phenotypes existed among patients with ARDS before the COVID-19 pandemic and to closely examine the Crs–mortality relationship. Methods: We undertook a secondary analysis of patients with ARDS, who were invasively ventilated on controlled modes and enrolled in a large, multinational, epidemiological study. We assessed Crs, degree of hypoxemia, and associated Crs-based phenotypic patterns with their characteristics and outcomes. Measurements and Main Results: Among 1,117 patients with ARDS who met inclusion criteria, the median Crs was 30 (interquartile range, 23–40) ml/cm H(2)O. One hundred thirty-six (12%) patients had preserved Crs (≥50 ml/cm H(2)O; phenotype with low elastance [“phenotype L”]), and 827 (74%) patients had poor Crs (<40 ml/cm H(2)O; phenotype with high elastance [“phenotype H”]). Compared with those with phenotype L, patients with phenotype H were sicker and had more comorbidities and higher hospital mortality (32% vs. 45%; P < 0.05). A near complete dissociation between Pa(O(2))/Fi(O(2)) and Crs was observed. Of 136 patients with phenotype L, 58 (43%) had a Pa(O(2))/Fi(O(2)) < 150. In a multivariable-adjusted analysis, the Crs was independently associated with hospital mortality (adjusted odds ratio per ml/cm H(2)O increase, 0.988; 95% confidence interval, 0.979–0.996; P = 0.005). Conclusions: A wide range of Crs was observed in non–COVID-19 ARDS. Approximately one in eight patients had preserved Crs. Pa(O(2))/Fi(O(2)) and Crs were dissociated. Lower Crs was independently associated with higher mortality. The Crs–mortality relationship lacked a clear transition threshold. American Thoracic Society 2020-11-01 2020-11-01 /pmc/articles/PMC7605177/ /pubmed/32805143 http://dx.doi.org/10.1164/rccm.202005-2046OC Text en Copyright © 2020 by the American Thoracic Society https://creativecommons.org/licenses/by-nc-nd/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). For commercial usage and reprints, please contact Diane Gern (dgern@thoracic.org). |
spellingShingle | Original Articles Panwar, Rakshit Madotto, Fabiana Laffey, John G. Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title | Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title_full | Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title_fullStr | Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title_full_unstemmed | Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title_short | Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic |
title_sort | compliance phenotypes in early acute respiratory distress syndrome before the covid-19 pandemic |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605177/ https://www.ncbi.nlm.nih.gov/pubmed/32805143 http://dx.doi.org/10.1164/rccm.202005-2046OC |
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