Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS
Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS
复制标题
DOI：
10.1007/s00134-020-06192-2
复制
发表时间：
2020-07-29
影响因子：
38.9
通讯作者：
Villar, Jesus
中科院分区：
文献类型：
--
作者：
Ferrando, Carlos;Suarez-Sipmann, Fernando;Villar, Jesus
目的新冠肺炎患者机械通气ARDS患者的主要特点，以及对肺保护性通气策略的坚持程度尚不清楚。我们描述了新冠肺炎有创机械通气(MV)患者确诊的ARDS的特点和结果。方法这是一项多中心、前瞻性、观察性研究，研究对象是2020年3月12日至6月1日在36个西班牙和安道尔重症监护病房(ICU)收治的连续、机械通气的急性呼吸窘迫综合征(按柏林标准定义)的新冠肺炎患者(鼻拭子或咽拭子标本中确诊为SARS-CoV-2感染)。我们研究了新冠肺炎急性呼吸窘迫综合征患者的临床特征、呼吸机管理和临床结果，并将一些结果与非新冠肺炎急性呼吸窘迫综合征患者的其他相关研究进行了比较。结果共分析了742例患者完整的28天预后数据：轻度128例(17.1%)，中度331例(44.6%)，重度283例(38.1%)。在基线时，定义为有创机械通气的第一天，中位数(IQR)值为：潮气量6.9(6.3-7.8)ml/kg预计体重，呼气末正压12(11-14)cmH(2)O。呼吸系统顺应性35(27-45)ml/cmH(2)O，平台压25(22-29)cmH(2)O和驾驶压力12(10-16)cmH(2)O与其他研究中观察到的非新冠肺炎ARDS相似。分别有79%、76%和72%的患者使用了募集手法、俯卧位和神经肌肉阻滞剂。与重度急性呼吸窘迫综合征相比，轻度急性呼吸窘迫综合征患者28天死亡的风险较低[危险比(RR)0.56(95%可信区间0.33-0.93，p=0.026)]和中度急性呼吸窘迫综合征[危险比(RR)0.69(95%可信区间0.47-0.97)，p=0.035]。在非新冠肺炎ARDS患者中，28天的死亡率与其他观察性研究相似。结论在这个大的系列中，新冠肺炎ARDS患者具有与其他原因相似的特征，对肺保护性通气的依从性很高，28d死亡的风险随着ARDS严重程度的增加而增加。
Purpose The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH(2)O. Values of respiratory system compliance 35 (27-45) ml/cmH(2)O, plateau pressure 25 (22-29) cmH(2)O, and driving pressure 12 (10-16) cmH(2)O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93),p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97),p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.