Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Panwar, Rakshit, Madotto, Fabiana, Laffey, John G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Thoracic Society 2020
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
_version_ 1783604261216583680
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
work_keys_str_mv AT panwarrakshit compliancephenotypesinearlyacuterespiratorydistresssyndromebeforethecovid19pandemic
AT madottofabiana compliancephenotypesinearlyacuterespiratorydistresssyndromebeforethecovid19pandemic
AT laffeyjohng compliancephenotypesinearlyacuterespiratorydistresssyndromebeforethecovid19pandemic