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Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study

PURPOSE: To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. MATERIALS AND METHODS: Prospective cohort study including consecutive mechanically ventilat...

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Autores principales: Estenssoro, Elisa, Loudet, Cecilia I., Dubin, Arnaldo, Kanoore Edul, Vanina S., Plotnikow, Gustavo, Andrian, Macarena, Romero, Ignacio, Sagardía, Judith, Bezzi, Marco, Mandich, Verónica, Groer, Carla, Torres, Sebastián, Orlandi, Cristina, Rubatto Birri, Paolo N., Valenti, María F., Cunto, Eleonora, Sáenz, María G., Tiribelli, Norberto, Aphalo, Vanina, Bettini, Lisandro, Ríos, Fernando G., Reina, Rosa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957289/
https://www.ncbi.nlm.nih.gov/pubmed/35349967
http://dx.doi.org/10.1016/j.jcrc.2022.154021
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author Estenssoro, Elisa
Loudet, Cecilia I.
Dubin, Arnaldo
Kanoore Edul, Vanina S.
Plotnikow, Gustavo
Andrian, Macarena
Romero, Ignacio
Sagardía, Judith
Bezzi, Marco
Mandich, Verónica
Groer, Carla
Torres, Sebastián
Orlandi, Cristina
Rubatto Birri, Paolo N.
Valenti, María F.
Cunto, Eleonora
Sáenz, María G.
Tiribelli, Norberto
Aphalo, Vanina
Bettini, Lisandro
Ríos, Fernando G.
Reina, Rosa
author_facet Estenssoro, Elisa
Loudet, Cecilia I.
Dubin, Arnaldo
Kanoore Edul, Vanina S.
Plotnikow, Gustavo
Andrian, Macarena
Romero, Ignacio
Sagardía, Judith
Bezzi, Marco
Mandich, Verónica
Groer, Carla
Torres, Sebastián
Orlandi, Cristina
Rubatto Birri, Paolo N.
Valenti, María F.
Cunto, Eleonora
Sáenz, María G.
Tiribelli, Norberto
Aphalo, Vanina
Bettini, Lisandro
Ríos, Fernando G.
Reina, Rosa
author_sort Estenssoro, Elisa
collection PubMed
description PURPOSE: To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. MATERIALS AND METHODS: Prospective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories. RESULTS: 1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH(2)O). PaO(2)/FiO(2), plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO(2)/FiO(2) over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio. CONCLUSION: Hypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required.
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spelling pubmed-89572892022-03-28 Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study Estenssoro, Elisa Loudet, Cecilia I. Dubin, Arnaldo Kanoore Edul, Vanina S. Plotnikow, Gustavo Andrian, Macarena Romero, Ignacio Sagardía, Judith Bezzi, Marco Mandich, Verónica Groer, Carla Torres, Sebastián Orlandi, Cristina Rubatto Birri, Paolo N. Valenti, María F. Cunto, Eleonora Sáenz, María G. Tiribelli, Norberto Aphalo, Vanina Bettini, Lisandro Ríos, Fernando G. Reina, Rosa J Crit Care Article PURPOSE: To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. MATERIALS AND METHODS: Prospective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories. RESULTS: 1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH(2)O). PaO(2)/FiO(2), plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO(2)/FiO(2) over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio. CONCLUSION: Hypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required. Elsevier Inc. 2022-10 2022-03-26 /pmc/articles/PMC8957289/ /pubmed/35349967 http://dx.doi.org/10.1016/j.jcrc.2022.154021 Text en © 2022 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Estenssoro, Elisa
Loudet, Cecilia I.
Dubin, Arnaldo
Kanoore Edul, Vanina S.
Plotnikow, Gustavo
Andrian, Macarena
Romero, Ignacio
Sagardía, Judith
Bezzi, Marco
Mandich, Verónica
Groer, Carla
Torres, Sebastián
Orlandi, Cristina
Rubatto Birri, Paolo N.
Valenti, María F.
Cunto, Eleonora
Sáenz, María G.
Tiribelli, Norberto
Aphalo, Vanina
Bettini, Lisandro
Ríos, Fernando G.
Reina, Rosa
Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title_full Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title_fullStr Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title_full_unstemmed Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title_short Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study
title_sort clinical characteristics, respiratory management, and determinants of oxygenation in covid-19 ards: a prospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957289/
https://www.ncbi.nlm.nih.gov/pubmed/35349967
http://dx.doi.org/10.1016/j.jcrc.2022.154021
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