An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

Autores da FMUP

• Sérgio Mina Gaião

  Autor

• Roberto Liberal Fernandes Roncon Albuquerque

  Autor

Participantes de fora da FMUP

• Li Bassi, G
• Suen, JY
• Dalton, HJ
• White, N
• Shrapnel, S
• Fanning, JP
• Liquet, B
• Hinton, S
• Booth, G
• Millar, JE
• Forsyth, S
• Fan, E
• Corley, A
• Ichiba, S
• Murthy, S
• Nichol, A
• Ng, PY
• Ogino, M
• Pesenti, A
• Trieu, HT
• Fraser, JF
• Al-Dabbous, T
• Alfoudri, H
• Shamsah, M
• Elapavaluru, S
• Berg, A
• Horn, C
• Schroll, S
• Velazco, J
• Fikes, W
• Ploskanych, L
• Meyer, D
• Shalabi-McGuire, M
• Witt, T
• Ehlers, A
• Grazioli, L
• Grandin, EW
• Nunez, J
• Reyes, T
• Joseph, M
• Mitchell, B
• Tenzer, M
• Abe, R
• Hayashi, Y
• Cho, HJ
• Jeong, IS
• Brozzi, N
• Hernandez-Montfort, J
• Mehkri, O
• Houltham, S
• Graf, J
• Perez, R
• Diaz, R
• Delgado, C
• Gonz?lez, J
• Sanchez, MS
• Rinc?n, DFB
• Duque, MB
• Yanten, AMM
• Brodie, D
• Rusmawatiningtyas, D
• Ragazzo, G
• Taufik, A
• Gunawan, M
• Irawany, V
• Rayhan, M
• Wardoyo, EY
• Panigada, M
• Coppola, S
• Colombo, S
• Grasselli, G
• Leone, M
• Zanella, A
• Antonelli, M
• Carelli, S
• Grieco, DL
• Asaki, M
• Salazar, L
• Duarte, L
• McCaffrey, J
• Bone, A
• Thomson, D
• Arnold-Day, C
• Cupido, J
• Fanie, Z
• Miller, M
• Seymore, L
• van Straaten, D
• Hassan, I
• Hssain, AA
• Aliudin, J
• Alqahtani, A
• Mohamed, K
• Mohamed, A
• Tan, D
• Villanueva, J
• Zaqout, A
• Kurtzman, E
• Ademi, A
• Dobrita, A
• Aoudi, KE
• Segura, J
• Giwangkancana, G
• Ohshimo, S
• Hoshino, K
• Hitoshi, S
• Uchinami, Y
• Osatnik, J
• Joosten, A
• Torres, A
• Motos, A
• Yang, M
• Luna, C
• Arancibia, F
• Williams, V
• Noel, A
• Luque, N
• Trung, TH
• Yacoub, S
• Fantini, M
• Garc?a, RNJ
• Alvarez, EC
• Greti, A
• Lomeli, O
• Ceccato, A
• Sanchez, A
• Vazquez, AL
• Roche-Campo, F
• Tuazon, D
• Duculan, T
• Amato, M
• Cassimiro, L
• Pola, F
• Ribeiro, F
• Fonseca, G
• Dalton, H
• Desai, M
• Osborn, E
• Deeb, H
• Arcadipane, A
• Bianco, C
• Cuffaro, R
• Martucci, G
• Occhipinti, G
• Rossetti, M
• Vitiello, C
• Cho, S
• Calligy, K
• Whitman, G
• Moriyama, N
• Kim, J
• Kitamura, N
• Shimazui, T
• Al-Hudaib, A
• Elhazmi, A
• Gebauer, J
• Yokoyama, T
• Al-Fares, A
• Alamad, E
• Alawadhi, F
• Alawadi, K
• Buabbas, S
• Tanaka, H
• Hashimoto, S
• Yamazaki, M
• Oh, T
• Epler, M
• Forney, C
• Feister, J
• Grobengieser, K
• Kruse, L
• Williamson, J
• Gnall, E
• Caroline, M
• Golden, S
• Karaj, C
• McDermott, S
• Sher, L
• Shapiro, T
• Thome, L
• Vanderland, M
• Welch, M
• Brazzi, L
• Ogston, T
• Nagpal, D
• Fischer, K
• Lorusso, R
• de Piero, M
• Esperatti, M
• O?Briain, D
• Carton, EG
• Sen, A
• Palacios, A
• Rainey, D
• Seefeldt, C
• Durham, L
• Falcucci, O
• Emmrich, A
• Guy, J
• Johns, C
• Neumann, E
• Buchtele, N
• Schwameis, M
• Stecher, S
• Singh, D
• Barnikel, M
• Arenz, L
• Zaaqoq, A
• Galloway, LA
• Merley, C
• Csete, M
• Quesada, L
• Saba, I
• Kasugai, D
• Hiraiwa, H
• Tanaka, T
• Marwali, E
• Purnama, Y
• Dewayanti, SR
• Ardiyan
• Siagian, D
• Chen, Y
• Laffey, J
• McNicholas, B
• Cosgrave, D
• VanDyk, M
• MacDonald, S
• Seppelt, I
• Ratsep, I
• Enneveer, L
• Erikson, K
• Oigus, G
• Post, A
• Sillaots, P
• Manetta, F
• Komats, M
• Satyapriya, SV
• Bhatt, A
• Echeverria, M
• Fiorda, J
• Gonzalez, A
• Mokadam, NA
• McKeown, J
• Pasek, J
• Shi, H
• Uribe, A
• Moreno, R
• Zakhary, B
• Johnson, H
• Pow, N
• Cavana, M
• Cucino, A
• Foti, G
• Giani, M
• Russotto, V
• Chiumello, D
• Castagna, V
• Dell?Amore, A
• Shum, H
• Vuysteke, A
• Usman, A
• Acker, A
• Mergler, B
• Rizer, N
• Sertic, F
• Smood, B
• Sperry, A
• Subramanian, M
• Lolong, N
• Akmal, E
• Burhan, E
• Rasmin, M
• Naivedh, B
• Sitompu, F
• Barrett, P
• Daugherty, J
• Dean, D
• Loforte, A
• Khan, I
• DeSantis, O
• Quraishi, MA
• Salt, G
• So, D
• Kandamby, D
• Mandei, JM
• Natanael, H
• YudhaLantang, E
• Lantang, A
• Jung, A
• Hammond, T
• Ng, G
• Ng, WY
• Yeung, P
• Adachi, S
• Blanco, P
• Prieto, A
• S?nchez, J
• Nicholson, M
• Farquharson, M
• Butt, W
• Serratore, A
• Delzoppo, C
• Janin, P
• Yarad, E
• Totaro, R
• Coles, J
• Balk, R
• Fox, S
• Hays, J
• Kapania, E
• Mishin, P
• Vissing, A
• Yantosh, G
• Yuliarto, S
• Santoso, KH
• Djajalaksana, S
• Fatoni, AZ
• Fukuda, M
• Liu, K
• Pelosi, P
• Battaglini, D
• Jim?nez, JFM
• Buchner, J
• Cho, Y
• Lee, SM
• Lee, SH
• Kawasaki, T
• Sakiyalak, P
• Nitayavardhana, P
• Seitz, T
• Arora, R
• Kent, D
• Parwar, S
• Cheng, A
• Miller, J
• Marino, D
• Deacon, JE
• Fujitani, S
• Shimizu, N
• Madhok, J
• Owyang, C
• Buscher, H
• Reynolds, C
• Maasikas, O
• Beljantsev, A
• Mihnovits, V
• Akimoto, T
• Aizawa, M
• Horibe, K
• Onodera, R
• Hodgson, C
• Young, M
• Smith, T
• Bartone, C
• George, T
• McGuinness, N
• Irvine, L
• Flynn, B
• Houchin, A
• Shimizu, K
• Hamaguchi, J
• Lussier, L
• Kersker, G
• Reich, JA
• Lotz, G
• Malfertheiner, M
• Dreier, E
• Maier, L
• Kusumastuti, NP
• McCloskey, C
• Dabaliz, A
• Elshazly, TB
• Smith, J
• Szuldrzynski, KS
• Biela?ski, P
• Hakeem, Y
• Wille, K
• Holt, R
• Parhar, KKS
• Fiest, KM
• Codan, C
• Shahid, A
• Fayed, M
• Evans, T
• Garcia, R
• Gutierrez, A
• Shimizu, H
• Song, T
• Rose, R
• Bennett, S
• Richardson, D
• Peek, G
• Lopez-Colon, D
• Arora, L
• Rappapport, K
• Rudolph, K
• Sibenaller, Z
• Stout, L
• Walter, A
• Herr, D
• Vedadi, N
• Sindt, L
• Ewald, C
• Hoffman, J
• Rajnic, S
• Thompson, S
• Kennedy, R
• Griffee, M
• Ciullo, A
• Kida, Y
• Roca, RF
• Alegre, C
• Contreras, S
• Riera, J
• Kay, C
• Fischer, I
• Renner, E
• Taniguci, H
• Abbate, G
• Hassan, H
• Heinsar, S
• Karnik, VA
• Ki, K
• O?Neill, HF
• Obonyo, N
• Pimenta, LP
• Reid, JD
• Sato, K
• Shekar, K
• Vuorinen, A
• Wildi, KS
• Wood, ES
• Yerkovich, S

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Heterogeneous respiratory system static compliance (<jats:italic>C</jats:italic><jats:sub>RS</jats:sub>) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>?calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]?and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> within the first seven days of MV. Median (IQR) age was 62 (52?71), patients were predominantly males (68%) and from Europe/North and South America (88%). <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>, within 48?h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (<jats:italic>p</jats:italic>?=?0.417) nor with PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub> (<jats:italic>p</jats:italic>?=?0.100). Females presented lower <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> than males (95% CI of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> difference between females-males: ??11.8 to ??7.4?mL/cmH<jats:sub>2</jats:sub>O <jats:italic>p</jats:italic>?<?0.001), and although females presented higher body mass index (BMI), association of BMI with <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> was marginal (<jats:italic>p</jats:italic>?=?0.139). Ventilatory management varied across <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> range, resulting in a significant association between <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> and driving pressure (estimated decrease ??0.31 cmH<jats:sub>2</jats:sub>O/L per mL/cmH<jats:sub>2</jats:sub>0 of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub>, 95% CI ??0.48 to ??0.14, <jats:italic>p</jats:italic>?<?0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> (+?10?mL/cm H<jats:sub>2</jats:sub>O) was only associated with being discharge from the ICU within 28?days (HR 1.14, 95% CI 1.02?1.28, <jats:italic>p</jats:italic>?=?0.018).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This multicentre report provides a comprehensive account of <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> in COVID-19 patients on MV. <jats:italic>C</jats:italic><jats:sub>RS</jats:sub> measured within 48?h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being d

Keywords

• Mechanical ventilation; Compliance; ARDS; COVID-19; SARS-CoV-2