Lung Recruitability in COVID-19-associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study.
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ABSTRACT:
SUBMITTER: Pan C
PROVIDER: S-EPMC7233342 | biostudies-literature | 2020 May
REPOSITORIES: biostudies-literature
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Lung Recruitability in COVID-19-associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study.
Pan Chun C Chen Lu L Lu Cong C Zhang Wei W Xia Jia-An JA Sklar Michael C MC Du Bin B Brochard Laurent L Qiu Haibo H
American journal of respiratory and critical care medicine 20200501 10
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Project description: Not available
| S-EPMC8048756 | biostudies-literature
Project description:ObjectiveThis study aimed to assess the effect of prone position on oxygenation and lung recruitability in patients with acute respiratory distress syndrome due to COVID-19 receiving invasive mechanical ventilation.MethodsThis prospective study was conducted in the intensive care unit between December 10, 2021, and February 10, 2022. We included 25 patients admitted to our intensive care unit with acute respiratory distress syndrome due to COVID-19 who had undergone prone position. We measured the respiratory system compliance, recruitment to inflation ratio, and PaO2/FiO2 ratio during the baseline supine, prone, and resupine positions. The recruitment to inflation ratio was used to assess the potential for lung recruitability.ResultsIn the prone position, PaO2/FiO2 increased from 82.7 to 164.4 mmHg (p<0.001) with an increase in respiratory system compliance (p=0.003). PaO2/FiO2 decreased to 117 mmHg (p=0.015) in the resupine with no change in respiratory system compliance (p=0.097). The recruitment to inflation ratio did not change in the prone and resupine positions (p=0.198 and p=0.621, respectively). In all patients, the median value of respiratory system compliance during supine was 26 mL/cmH2O. In patients with respiratory system compliance<26 mL/cmH2O (n=12), respiratory system compliance increased and recruitment to inflation decreased from supine to prone positions (p=0.008 and p=0.040, respectively), whereas they did not change in those with respiratory system compliance ≥26 mL/cmH2O8 (n=13) (p=0.279 and p=0.550, respectively) (ClinicalTrials registration number: NCT05150847).ConclusionIn the prone position, in addition to the oxygenation benefit in all patients, we detected lung recruitment based on the change in the recruitment to inflation ratio with an increase in respiratory system compliance only in acute respiratory distress syndrome due to COVID-19 patients who have <26 mL/cmH2O baseline supine respiratory compliance.
| S-EPMC10204839 | biostudies-literature
Project description:The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) varies from other pneumonia-related ARDS. We evaluated whether the mortality rates differed for COVID-19 and non-COVID-19-related ARDS in the Asian population in 2021. This single center retrospective observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included hospital length of stay, ICU length of stay, duration of mechanical ventilation, and ventilator-free days (VFDs) during the first 28 days. A 1:1 propensity score matching was performed to correct potential confounders by age, obesity or not, and ARDS severity. One-hundred-and-sixty-four patients fulfilled the inclusion criteria. After 1:1 propensity score matching, there were 50 patients in each group. The all-cause in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non-COVID-19-related ARDS (17 [34%) vs. 21 [42%], p = 0.410). Both groups had length of stay (30.0 [20.0-46.0] vs. 27.0 [13.0-45.0] days, p = 0.312), ICU length of stay (19.0 [13.0-35.0] vs. 16.0 [10.0-32.0] days, p = 0.249), length of mechanical ventilation (19.0 [10.0-36.0] vs. 14.0 [9.0-29.0] days, p = 0.488), and ventilator-free days during the first 28 days (5.5 [0.0-17.0] vs. 0.0 [0.0-14.0] days, p = 0.320). Immunocompromised status (Hazard ratio: 3.63; 95% CI: 1.51-8.74, p = 0.004) and progress to severe ARDS (Hazard ratio: 2.92; 95% CI: 1.18-7.22, p = 0.020) were significant in-hospital mortality-related confounders. There were no significant difference in mortality among both groups. Immunocompromised status and progression to severe ARDS are two possible risk factors for patients with ARDS; COVID-19 is not a mortality-related risk exposure.
| S-EPMC10237657 | biostudies-literature
Project description:BackgroundWe examined the effect of intubation time and the lung mechanics on clinical outcomes in coronavirus disease 2019 (COVID-19) patients.MethodsBased on the patient's hospital admission, intubation time was defined as early (≤ 2 days) or late (> 2 days). Patients were further divided into three groups; early (≤ 3 days), late (4 - 6 days), and very late (> 6 days) intubated.ResultsA total of 194 patients were included; 66.5% male, median age 65 years. Fifty-eight patients (29.9%) were intubated early and 136 (70.1%) late. Early intubated patients revealed lower mortality (44.8% vs. 72%, P < 0.001), were younger (60 vs. 67, P = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs. 8, P = 0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs. 36, P = 0.006; 40 vs. 33, P < 0.001; and 37.5 vs. 32, P < 0.001, respectively). Older age (adjusted odds ratio (aOR) = 1.15, P < 0.001), intubation time (aOR = 1.15, P = 0.004), high SOFA scores (aOR = 1.81, P < 0.001), low partial pressure of oxygen (PaO2)/fractional inspired oxygen tension (FiO2) ratio (aOR = 0.96, P = 0.001), and low lung compliance on admission days 1 and 12 (aOR = 1.12, P = 0.012 and aOR = 1.14, P < 0.001, respectively) were associated with higher mortality. Very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs. 63.4% vs. 44.6%, respectively, P < 0.001).ConclusionsAmong COVID-19 intubated patients, age, late intubation, high SOFA scores, low PaO2/FiO2 ratio, and low lung compliance are associated with higher intensive care unit (ICU) mortality.
| S-EPMC10846488 | biostudies-literature
Project description:BACKGROUND:A large proportion of patients with a SARS-Cov-2-associated respiratory failure develop an acute respiratory distress syndrome (ARDS). It has been recently suggested that SARS-Cov-2-associated ARDS may differ from usual non-SARS-Cov-2-associated ARDS by higher respiratory system compliance (CRS), lower potential for recruitment with positive end-expiratory pressure (PEEP) contrasting with severe shunt fraction. The purpose of the study was to systematically assess respiratory mechanics and recruitability in SARS-Cov-2-associated ARDS. METHODS:Gas exchanges, CRS and hemodynamics were assessed at 2 levels of PEEP (15 cmH2O and 5 cmH2O) within 36 h (day1) and from 4 to 6 days (day 5) after intubation. The recruited volume was computed as the difference between the volume expired from PEEP 15 to 5 cmH2O and the volume predicted by compliance at PEEP 5 cmH2O (or above airway opening pressure). The recruitment-to-inflation (R/I) ratio (i.e. the ratio between the recruited lung compliance and CRS at PEEP 5 cmH2O) was used to assess lung recruitability. A R/I ratio value higher than or equal to 0.5 was used to define highly recruitable patients. RESULTS:The R/I ratio was calculated in 25 of the 26 enrolled patients at day 1 and in 15 patients at day 5. At day 1, 16 (64%) were considered as highly recruitable (R/I ratio median [interquartile range] 0.7 [0.55-0.94]) and 9 (36%) were considered as poorly recruitable (R/I ratio 0.41 [0.31-0.48]). The PaO2/FiO2 ratio at PEEP 15 cmH2O was higher compared to PEEP 5 cmH2O only in highly recruitable patients (173 [139-236] vs 135 [89-167] mmHg; p < 0.01). Neither PaO2/FiO2 or CRS measured at PEEP 15 cmH2O or at PEEP 5 cmH2O nor changes in PaO2/FiO2 or CRS in response to PEEP changes allowed to identify highly or poorly recruitable patients. CONCLUSION:In this series of 25 patients with SARS-Cov-2 associated ARDS, 64% were considered as highly recruitable and only 36% as poorly recruitable based on the R/I ratio performed on the day of intubation. This observation suggests that a systematic R/I ratio assessment may help to guide initial PEEP titration to limit harmful effect of unnecessary high PEEP in the context of Covid-19 crisis.
| S-EPMC7215140 | biostudies-literature
Project description:BackgroundMitochondrial DNA (mtDNA) has been reported to play a critical role in the progression of systemic inflammatory response syndrome (SIRS). The pathophysiology of acute respiratory distress syndrome (ARDS) is mainly attributed to the diffuse injury of alveolar epithelial cells caused by dysregulated inflammation upon direct or indirect insults. We hypothesized that plasma mtDNA may serve as an early biomarker that can predict the outcome of patients with ARDS.MethodsThis study was conducted in the Department of Critical Care Medicine, Zhongda Hospital, Southeast University, a tertiary teaching hospital, from 1 May 2016 to 31 January 2017. Patients diagnosed with ARDS at admission were screened. The levels of plasma mtDNA on Day 1, Day 3 and Day 7 were detected by real-time quantitative PCR (RT-qPCR). The patients were followed-up, and all-cause mortality was recorded. The prognostic values of plasma mtDNA were evaluated in ARDS patients using receiver operating characteristic (ROC) analysis.ResultsIn total, 136 patients with ARDS were prospectively screened, and 73 patients were finally enrolled, with a 28-day mortality of 39.7% (29 of 73 patients). The plasma mtDNA levels at Day 7 of mild, moderate and severe ARDS patients were 1,230 (588-22,387), 5,370 (628-13,052) and 15,792 (1,623-186,814), respectively (copies/µL, P<0.05) Compared with the survivors, the level of plasma mtDNA in the nonsurvivors was significantly higher on Day 7 [67,608 (19,498-346,736) vs. 7,585 (1,717-15,792) copies/µL; P<0.05]. The AUROC of plasma mtDNA on Day 7 for predictive mortality in patients with ARDS was 0.74, and the optimal cut-off value was 18,640 copies/µL.ConclusionsPlasma mtDNA levels were positively associated with the severity of ARDS. Higher plasma mtDNA levels on Day 7 indicated a poor outcome in ARDS patients.
| S-EPMC7212167 | biostudies-literature
Project description:Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included. Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients.
| S-EPMC7775385 | biostudies-literature
Project description:BackgroundSepsis-associated destruction of the pulmonary microvascular endothelial glycocalyx (EGCX) creates a vulnerable endothelial surface, contributing to the development of acute respiratory distress syndrome (ARDS). Constituents of the EGCX shed into circulation, glycosaminoglycans and proteoglycans, may serve as biomarkers of endothelial dysfunction. We sought to define the patterns of plasma EGCX degradation products in children with sepsis-associated pediatric ARDS (PARDS), and test their association with clinical outcomes.MethodsWe retrospectively analyzed a prospective cohort (2018-2020) of children (≥1 month to <18 years of age) receiving invasive mechanical ventilation for acute respiratory failure for ≥72 h. Children with and without sepsis-associated PARDS were selected from the parent cohort and compared. Blood was collected at time of enrollment. Plasma glycosaminoglycan disaccharide class (heparan sulfate, chondroitin sulfate, and hyaluronan) and sulfation subtypes (heparan sulfate and chondroitin sulfate) were quantified using liquid chromatography tandem mass spectrometry. Plasma proteoglycans (syndecan-1) were measured through an immunoassay.ResultsAmong the 39 mechanically ventilated children (29 with and 10 without sepsis-associated PARDS), sepsis-associated PARDS patients demonstrated higher levels of heparan sulfate (median 639 ng/mL [interquartile range, IQR 421-902] vs 311 [IQR 228-461]) and syndecan-1 (median 146 ng/mL [IQR 32-315] vs 8 [IQR 8-50]), both p = 0.01. Heparan sulfate subtype analysis demonstrated greater proportions of N-sulfated disaccharide levels among children with sepsis-associated PARDS (p = 0.01). Increasing N-sulfated disaccharide levels by quartile were associated with severe PARDS (n = 9/29) with the highest quartile including >60% of the severe PARDS patients (test for trend, p = 0.04). Higher total heparan sulfate and N-sulfated disaccharide levels were independently associated with fewer 28-day ventilator-free days in children with sepsis-associated PARDS (all p < 0.05).ConclusionsChildren with sepsis-associated PARDS exhibited higher plasma levels of heparan sulfate disaccharides and syndecan-1, suggesting that EGCX degradation biomarkers may provide insights into endothelial dysfunction and PARDS pathobiology.
| S-EPMC10845819 | biostudies-literature
Project description:ObjectiveWe evaluated pressure-controlled ventilation (PCV) with multiple programmed levels of positive end expiratory pressure (programmed multi-level ventilation; PMLV) in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS).MethodsWe conducted a multicenter, retrospective study from November 2020 to February 2021. PMLV was used with PCV in all patients with intensive care admission until improvement in oxygenation (fraction of inspired oxygen [FiO2] ≤0.50 and oxygen saturation [SpO2] >92%). The observed outcomes were improvement of hypoxemia, length of mechanical ventilation, partial pressure of carbon dioxide (PaCO2) stability, and adverse events.ResultsOf 188 mechanically ventilated patients with COVID-19-related ARDS, we analyzed 60 patients treated with PMLV. Hypoxemia improved in 55 (92%) patients, as measured by the change in partial pressure of oxygen/FiO2 and SpO2/FiO2 ratios on day 3 versus day 1, and in 32 (66%) ventilated patients on day 7 versus day 3. The median (interquartile range) length of mechanical ventilation for survivors and non-survivors was 8.4 (4.7-14.9) and 6.7 (3.6-10.3) days, respectively.ConclusionsPMLV appears to be a safe and effective ventilation strategy for improving hypoxemia in patients with COVID-19-related ARDS. Further studies are needed comparing the PMLV mode with the conventional ARDS ventilatory approach.
| S-EPMC9158417 | biostudies-literature
Project description: Not available
| S-EPMC7427374 | biostudies-literature