Comparing Clinical Features and Outcomes in Mechanically Ventilated Patients with COVID-19 and Acute Respiratory Distress Syndrome

被引:40
作者
Sjoding, Michael W. [1 ,2 ,3 ,4 ]
Admon, Andrew J. [1 ,4 ]
Saha, Anjan K. [5 ]
Kay, Stephen G. [1 ]
Brown, Christopher A. [1 ]
Co, Ivan [1 ,6 ]
Claar, Dru [1 ]
McSparron, Jakob, I [1 ]
Dickson, Robert P. [1 ,3 ,7 ]
机构
[1] Univ Michigan, Div Pulm & Crit Care Med, Dept Internal Med, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Dept Computat Med & Bioinformat, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Michigan Ctr Integrat Res Crit Care, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Inst Healthcare Policy & Innovat, Ann Arbor, MI 48109 USA
[5] Dept Internal Med, Div Infect Dis, Univ Michigan, Med Sch, Ann Arbor, MI 48109 USA
[6] Dept Internal Med, Dept Emergency Med, Med Sch, Ann Arbor, MI 48109 USA
[7] Univ Michigan, Med Sch, Dept Microbiol & Immunol, Ann Arbor, MI 48109 USA
关键词
COVID-19; ARDS; physiology; outcomes; NEW-YORK-CITY; ARDS; SUBPHENOTYPES; TOCILIZUMAB; IMPUTATION;
D O I
10.1513/AnnalsATS.202008-1076OC
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Rationale: Patients with severe coronavirus disease (COVID-19) meet clinical criteria for the acute respiratory distress syndrome (ARDS), yet early reports suggested they differ physiologically and clinically from patients with non-COVID-19 ARDS, prompting treatment recommendations that deviate from standard evidence-based practices for ARDS. Objectives: To compare respiratory physiology, clinical outcomes, and extrapulmonary clinical features of severe COVID19 with non-COVID-19 ARDS. Methods: We performed a retrospective cohort study, comparing 130 consecutive mechanically ventilated patients with severe COVID-19 with 382 consecutive mechanically ventilated patients with non-COVID-19 ARDS. Initial respiratory physiology and 28-day outcomes were compared. Extrapulmonary manifestations (inflammation, extrapulmonary organ injury, and coagulation) were compared in an exploratory analysis. Results: Comparison of patients with COVID-19 and non-COVID-19 ARDS suggested small differences in respiratory compliance, ventilatory efficiency, and oxygenation. The 28-day mortality was 30% in patients with COVID-19 and 38% in patients with non-COVID-19 ARDS. In adjusted analysis, point estimates of differences in time to breathing unassisted at 28 days (adjusted subdistributional hazards ratio, 0.98 [95% confidence interval (CI), 0.77-1.26]) and 28-day mortality (risk ratio, 1.01 [95% CI, 0.72-1.42]) were small for COVID-19 versus non-COVID-19 ARDS, although the confidence intervals for these estimates include moderate differences. Patients with COVID-19 had lower neutrophil counts but did not differ in lymphocyte count or other measures of systemic inflammation. Conclusions: In this single-center cohort, we found no evidence for large differences between COVID-19 and non-COVID-19 ARDS. Many key clinical features of severe COVID-19 were similar to those of non-COVID-19 ARDS, including respiratory physiology and clinical outcomes, although our sample size precludes definitive conclusions. Further studies are needed to define COVID-19-specific pathophysiology before a deviation from evidence-based treatment practices can be recommended.
引用
收藏
页码:1876 / 1885
页数:10
相关论文
共 68 条
  • [11] COVID-19-versus non-COVID-19-related Acute Respiratory Distress Syndrome: Differences and Similarities
    Brault, Clement
    Zerbib, Yoann
    Kontar, Loay
    Fouquet, Ugo
    Carpentier, Mathieu
    Metzelard, Matthieu
    Soupison, Thierry
    De Cagny, Bertrand
    Maizel, Julien
    Slama, Michel
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2020, 202 (09) : 1301 - 1304
  • [12] BROMAGE PR, 1958, CLIN SCI, V17, P217
  • [13] Nonlinear Imputation of PaO2/FIO2 From SpO2/FIO2 Among Patients With Acute Respiratory Distress Syndrome
    Brown, Samuel M.
    Grissom, Colin K.
    Moss, Marc
    Rice, Todd W.
    Schoenfeld, David
    Hou, Peter C.
    Thompson, B. Taylor
    Brower, Roy G.
    [J]. CHEST, 2016, 150 (02) : 307 - 313
  • [14] Distinct Molecular Phenotypes of Direct vs Indirect ARDS in Single-Center and Multicenter Studies
    Calfee, Carolyn S.
    Janz, David R.
    Bernard, Gordon R.
    May, Addison K.
    Kangelaris, Kirsten N.
    Matthay, Michael A.
    Ware, Lorraine B.
    [J]. CHEST, 2015, 147 (06) : 1539 - 1548
  • [15] Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials
    Calfee, Carolyn S.
    Delucchi, Kevin
    Parsons, Polly E.
    Thompson, B. Taylor
    Ware, Lorraine B.
    Matthay, Michael A.
    [J]. LANCET RESPIRATORY MEDICINE, 2014, 2 (08) : 611 - 620
  • [16] Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study
    Chiumello, Davide
    Busana, Mattia
    Coppola, Silvia
    Romitti, Federica
    Formenti, Paolo
    Bonifazi, Matteo
    Pozzi, Tommaso
    Palumbo, Maria Michela
    Cressoni, Massimo
    Herrmann, Peter
    Meissner, Konrad
    Quintel, Michael
    Camporota, Luigi
    Marini, John J.
    Gattinoni, Luciano
    [J]. INTENSIVE CARE MEDICINE, 2020, 46 (12) : 2187 - 2196
  • [17] Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial
    Constantin, Jean-Michel
    Jabaudon, Matthieu
    Lefrant, Jean-Yves
    Jaber, Samir
    Quenot, Jean-Pierre
    Langeron, Olivier
    Ferrandiere, Martine
    Grelon, Fabien
    Seguin, Philippe
    Ichai, Carole
    Veber, Benoit
    Souweine, Bertrand
    Uberti, Thomas
    Lasocki, Sigismond
    Legay, Francois
    Leone, Marc
    Eisenmann, Nathanael
    Dahyot-Fizelier, Claire
    Dupont, Herve
    Asehnoune, Karim
    Sossou, Achille
    Chanques, Gerald
    Muller, Laurent
    Bazin, Jean-Etienne
    Monsel, Antoine
    Borao, Lucile
    Garcier, Jean-Marc
    Rouby, Jean-Jacques
    Pereira, Bruno
    Futier, Emmanuel
    [J]. LANCET RESPIRATORY MEDICINE, 2019, 7 (10) : 870 - 880
  • [18] Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study
    Cummings, Matthew J.
    Baldwin, Matthew R.
    Abrams, Darryl
    Jacobson, Samuel D.
    Meyer, Benjamin J.
    Balough, Elizabeth M.
    Aaron, Justin G.
    Claassen, Jan
    Rabbani, LeRoy E.
    Hastie, Jonathan
    Hochman, Beth R.
    Salazar-Schicchi, John
    Yip, Natalie H.
    Brodie, Daniel
    O'Donnell, Max R.
    [J]. LANCET, 2020, 395 (10239) : 1763 - 1770
  • [19] Stability of ARDS subphenotypes over time in two randomised controlled trials
    Delucchi, Kevin
    Famous, Katie R.
    Ware, Lorraine B.
    Parsons, Polly E.
    Thompson, B. Taylor
    Calfee, Carolyn S.
    [J]. THORAX, 2018, 73 (05) : 439 - 445
  • [20] Oxygenation Saturation Index Predicts Clinical Outcomes in ARDS
    DesPrez, Katherine
    McNeil, J. Brennan
    Wang, Chunxue
    Bastarache, Julie A.
    Shaver, Ciara M.
    Ware, Lorraine B.
    [J]. CHEST, 2017, 152 (06) : 1151 - 1158