Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies
Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies
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DOI：
10.1186/s13054-020-03253-2
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发表时间：
2020-08-28
期刊：
影响因子：
15.1
通讯作者：
Antonelli, Massimo
中科院分区：
文献类型：
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作者：
Grieco, Domenico Luca;Bongiovanni, Filippo;Antonelli, Massimo
背景COVID-19引起的呼吸衰竭的呼吸生理学是否与其他病因的急性呼吸窘迫综合征（ARDS）不同尚不清楚。我们进行了一项单中心研究，以描述COVID-19 ARDS的呼吸力学和对呼气末正压（PEEP）的反应，并将COVID-19患者与其他原因导致的ARDS患者进行比较。Methods 30例连续COVID-19患者在罗马，意大利的重症监护室入院，并在气管插管后24小时内符合中度至重度ARDS标准。在PEEP为15和5cmH（2）O时，测定气体交换、呼吸力学和呼气比。进行单次呼吸去复张操作以评估复张能力。根据PaO 2/FiO（2）、FiO（2）、PEEP和潮气量进行1：1匹配后，将COVID-19患者与其他病因的ARDS受试者进行比较，这些受试者在先前的研究中接受了相同的程序。在低PEEP时，两组的中位[第25 - 75次] PaO 2/FiO（2）分别为119 mmHg [101-142]和116 mmHg [87-154]。COVID-19患者的平均顺应性（41 ml/cmH（2）O [32-52] vs. 36 ml/cmH（2）O [27-42]，p =0.045）和舒张比（2.1 [1.7-2.3] vs. 1.6 [1.4-2.1]，p =0.032）略高。COVID-19患者依从性的个体间变异性（标准差与平均值的比值）为36%，其他ARDS患者为31%。在COVID-19患者中，PaO 2/FiO（2）与呼吸系统顺应性呈线性相关（r =0.52 p =0.003）。高PEEP改善了两个队列的PaO 2/FiO（2），但在COVID-19患者中更为显著（p =0.005）。队列之间的招募率没有差异（p =0.39），个体间差异很大（COVID-19患者为72%，其他原因的ARDS为64%）。在COVID-19患者中，复吸率与PEEP.ConclusionsEarly氧合和呼吸力学变化无关，机械通气建立后，COVID-19患者遵循ARDS生理学，与低氧血症程度相关的顺应性降低，以及个体间可变的呼吸力学和复吸率。COVID-19和其他原因引起的ARDS之间的生理差异似乎很小。
BackgroundWhether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes.MethodsThirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5cmH(2)O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO2/FiO(2), FiO(2), PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study.ResultsThirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th-75th percentiles] PaO2/FiO(2) in the two groups was 119mmHg [101-142] and 116mmHg [87-154]. Average compliance (41ml/cmH(2)O [32-52] vs. 36ml/cmH(2)O [27-42], p =0.045) and ventilatory ratio (2.1 [1.7-2.3] vs. 1.6 [1.4-2.1], p =0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO2/FiO(2) was linearly correlated with respiratory system compliance (r =0.52 p =0.003). High PEEP improved PaO2/FiO(2) in both cohorts, but more remarkably in COVID-19 patients (p =0.005). Recruitability was not different between cohorts (p =0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP.ConclusionsEarly after establishment of mechanical ventilation, COVID-19 patients follow ARDS physiology, with compliance reduction related to the degree of hypoxemia, and inter-individually variable respiratory mechanics and recruitability. Physiological differences between ARDS from COVID-19 and other causes appear small.