ARDS in COVID-19 patients looks familiar: large observational study

  • Intensive Care Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Standard lung-protective ventilatory strategies may suffice for patients with COVID-19 and acute respiratory distress syndrome (ARDS). 

Why this matters

  • Near-normal respiratory compliance has been reported in patients with COVID-19-positive ARDS.
  • Whether ARDS resulting from COVID-19 calls for a nonstandard approach to mechanical ventilation has been a topic of debate.

Key results

  • Compliance data were available in ~40%.
    • Of those, 78% had low compliance; in more than one-third, it was severe.
  • Median values were statistically comparable to those in large studies of patients with non-COVID ARDS:
    • Baseline compliance of respiratory system (Crs), plateau pressure, driving pressure.
    • 28-day all-cause mortality. 
  • Tidal volume, positive end-expiratory pressure (PEEP) did not vary with Crs, severity of lung disease.
  • Median tidal volumes: 
    • Baseline: 6.9 (interquartile range [IQR], 6.3-7.8) mL/kg predicted body weight (PBW).
    • Highest: 8.4 (IQR, 7.3-9.5) mL/kg PBW.
  • Median PEEP: 
    • Baseline: 12 (IQR, 11-14) cmH2O.
    • Highest: 14 (IQR, 12-15) cmH2O.

Study design

  • Multicenter, prospective, observational study of patients with COVID-19 and ARDS undergoing mechanical ventilation at 36 Iberian ICUs in March and June, 2020 (n=742).
  • Authors reported clinical features, ventilator settings, outcomes.
  • Funding: Instituto de Salud Carlos III (Spain); Canadian Institutes of Health Research.

Limitations

  • Nonrandomized.
  • Ventilatory strategies could not be linked to outcomes.