Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

Adel Maamar; Pauline Guillot; Vincent Joussellin; Flora Delamaire; Benoit Painvin; Anaëlle Bichon; Océane Bernard de la Jartre; Matteo Mauget; Mathieu Lesouhaitier; Jean Marc Tadié; Nicolas Terzi; Arnaud Gacouin

doi:10.1183/23120541.00554-2022

Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

ERJ Open Res. 2023 Apr 11;9(2):00554-2022. doi: 10.1183/23120541.00554-2022. eCollection 2023 Mar.

Authors

Adel Maamar^{1

2}, Pauline Guillot^{1

2}, Vincent Joussellin^{1

2}, Flora Delamaire^{1

2}, Benoit Painvin^{1

2}, Anaëlle Bichon^{1

2}, Océane Bernard de la Jartre^{1

2}, Matteo Mauget^{1

2}, Mathieu Lesouhaitier^{1

2

3}, Jean Marc Tadié^{1

2

3}, Nicolas Terzi^{1

2

3}, Arnaud Gacouin^{1

2

3}

Affiliations

¹ Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.
² Faculté de Médecine, Biosit, Université Rennes I, Rennes, France.
³ Inserm CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, Rennes, France.

Abstract

Background: This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P _aO₂ )/inspiratory oxygen fraction (F _IO₂ ) ≤150 mmHg.

Methods: We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C _rs), ventilator ratio, corrected minute ventilation (V'_Ecorr) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.

Results: On day 1 of ARDS, COVID-19 patients had significantly higher P _aO₂ /F _IO₂ (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH₂O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V'_Ecorr (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min^-1; p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P _aO₂ /F _IO₂ , arterial carbon dioxide tension, ventilatory ratio and V'_Ecorr differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43).

Conclusions: Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.