Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome.
Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome.
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DOI：
10.1186/s13054-021-03665-8
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发表时间：
2021-07-15
期刊：
影响因子：
--
通讯作者：
Meziani F
中科院分区：
文献类型：
--
作者：
Beloncle F;Studer A;Seegers V;Richard JC;Desprez C;Fage N;Merdji H;Pavlovsky B;Helms J;Cunat S;Mortaza S;Demiselle J;Brochard L;Mercat A;Meziani F
COVID-19和非COVID-19患者之间的ARDS生理学差异已被描述。本研究旨在比较氧合匹配的COVID-19和非COVID-19肺ARDS患者的呼吸系统顺应性（CRS）、氧合参数和呼吸比（VR）的初始值和纵向变化。 来自两个中心的135名COVID-19 ARDS患者被纳入一项生理学研究;来自一项临床试验的767名非COVID-19 ARDS患者被用于至少1：2匹配的目的。倾向匹配基于年龄、严重程度评分、氧合、呼气末正压（PEEP）和ARDS的肺部原因，并允许包括112例COVID-19和198例非COVID肺部ARDS。 两组在初始氧合方面相似。COVID-19患者的体重指数较高，第1天的CRS较高（中位数[IQR]，35 [28-44] vs 32 [26-38] ml cmH 2 O −1，p = 0.037）。在第1天，CRS仅与非COVID-19患者的氧合相关; 61.6%和68.2%的COVID-19和非COVID-19肺ARDS患者在第7天仍有通气（p = 0.241）。在第3天和第7天，COVID-19患者的氧合水平低于非COVID-19患者，而CRS变得相似。在COVID-19患者中，VR在第1天低于非COVID-19患者，但仅在COVID-19患者中从第1天到第7天增加。与加热加湿器相比，使用热湿交换器通气的COVID-19患者在第1、3和7天的VR更高。调整PaO 2/FiO 2、PEEP和湿化装置后，发现COVID-19和非COVID-19患者在第7天的CRS和VR无差异。28天死亡率在COVID-19和非COVID-19患者之间没有差异（分别为25.9%和23.7%，p = 0.666）。对于类似的初始氧合，COVID-19 ARDS最初与经典ARDS的不同之处在于与氧合分离的较高CRS。CRS在进展的第一周内对于仍然接受机械通气的患者变得相似，但COVID-19患者的氧合变得更低。试验注册：clinicaltrials.gov NCT 04385004在线版本包含补充材料，可在10.1186/s13054-021-03665-8获得。
Differences in physiology of ARDS have been described between COVID-19 and non-COVID-19 patients. This study aimed to compare initial values and longitudinal changes in respiratory system compliance (CRS), oxygenation parameters and ventilatory ratio (VR) in patients with COVID-19 and non-COVID-19 pulmonary ARDS matched on oxygenation. 135 patients with COVID-19 ARDS from two centers were included in a physiological study; 767 non-COVID-19 ARDS from a clinical trial were used for the purpose of at least 1:2 matching. A propensity-matching was based on age, severity score, oxygenation, positive end-expiratory pressure (PEEP) and pulmonary cause of ARDS and allowed to include 112 COVID-19 and 198 non-COVID pulmonary ARDS. The two groups were similar on initial oxygenation. COVID-19 patients had a higher body mass index, higher CRS at day 1 (median [IQR], 35 [28–44] vs 32 [26–38] ml cmH2O−1, p = 0.037). At day 1, CRS was correlated with oxygenation only in non-COVID-19 patients; 61.6% and 68.2% of COVID-19 and non-COVID-19 pulmonary ARDS were still ventilated at day 7 (p = 0.241). Oxygenation became lower in COVID-19 than in non-COVID-19 patients at days 3 and 7, while CRS became similar. VR was lower at day 1 in COVID-19 than in non-COVID-19 patients but increased from day 1 to 7 only in COVID-19 patients. VR was higher at days 1, 3 and 7 in the COVID-19 patients ventilated using heat and moisture exchangers compared to heated humidifiers. After adjustment on PaO2/FiO2, PEEP and humidification device, CRS and VR were found not different between COVID-19 and non-COVID-19 patients at day 7. Day-28 mortality did not differ between COVID-19 and non-COVID-19 patients (25.9% and 23.7%, respectively, p = 0.666). For a similar initial oxygenation, COVID-19 ARDS initially differs from classical ARDS by a higher CRS, dissociated from oxygenation. CRS become similar for patients remaining on mechanical ventilation during the first week of evolution, but oxygenation becomes lower in COVID-19 patients. Trial registration: clinicaltrials.gov NCT04385004 The online version contains supplementary material available at 10.1186/s13054-021-03665-8.
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影响因子：
24.3
作者：
Pelosi, P;D'Onofrio, D;Gattinoni, L
通讯作者：
Gattinoni, L
影响因子：
120.7
作者：
Mercat, Alain;Richard, Jean-Christophe M.;Brochard, Laurent
通讯作者：
Brochard, Laurent
DOI：
10.1016/s2213-2600(20)30370-2
发表时间：
2020-12
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Grasselli G;Tonetti T;Protti A;Langer T;Girardis M;Bellani G;Laffey J;Carrafiello G;Carsana L;Rizzuto C;Zanella A;Scaravilli V;Pizzilli G;Grieco DL;Di Meglio L;de Pascale G;Lanza E;Monteduro F;Zompatori M;Filippini C;Locatelli F;Cecconi M;Fumagalli R;Nava S;Vincent JL;Antonelli M;Slutsky AS;Pesenti A;Ranieri VM;collaborators
通讯作者：
collaborators
DOI：
10.1164/rccm.201804-0692oc
发表时间：
2019-02-01
影响因子：
24.7
作者：
Sinha, Pratik;Calfee, Carolyn S.;Kallet, Richard H.
通讯作者：
Kallet, Richard H.
DOI：
10.1164/rccm.202004-1412oc
发表时间：
2020-09-01
影响因子：
24.7
作者：
Patel, Brijesh, V;Arachchillage, Deepa J.;Desai, Sujal R.
通讯作者：
Desai, Sujal R.