In:
Annals of the Academy of Medicine, Singapore, Academy of Medicine, Singapore, Vol. 50, No. 9 ( 2021-9-30), p. 686-694
Abstract:
ABSTRACT
Introduction: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to
measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS.
Methods: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences
between high ( 〈 40mL/cm H2O) and low ( 〈 40mL/cm H2O) compliance were analysed.
Results: A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile
range [IQR] 67–75 versus median 61 years, IQR 52–66; P 〈 0.01), and required a longer duration of
ventilation (26 days, IQR 12–27 vs 8 days, IQR 5–15; P 〈 0.01) and intensive care unit support
(26 days, IQR 11–30 vs 11.5 days, IQR 7–17.3; P=0.01), with a higher incidence of acute kidney injury (15 patients [100%] vs 40 patients [46%] ; P 〈 0.01). There were 67 patients who had lung compliance
data; 24 (35.8%) were classified as having high compliance and 43 (64.2%) as having low compliance. Mortality was higher in patients with high compliance (33.3% vs 11.6%; P=0.03), and was associated
with a drop in compliance at day 7 (-9.3mL/cm H2O (IQR -4.5 to -15.4) vs 0.2mL/cm H2O (4.7 to -5.2) P=0.04).
Conclusion: COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.
Keywords: ARDS, COVID-19-associated respiratory failure, high-flow nasal cannula therapy, HFNC, post-intubation, ventilation strategies
Type of Medium:
Online Resource
ISSN:
0304-4602
DOI:
10.47102/annals-acadmedsg.
DOI:
10.47102/annals-acadmedsg.2021129
Language:
English
Publisher:
Academy of Medicine, Singapore
Publication Date:
2021
detail.hit.zdb_id:
2186627-2
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