Epidemiology, ventilation management and outcomes of COVID–19 ARDS patients versus patients with ARDS due to pneumonia in the Pre–COVID era
Fleur–Stefanie L. I. M. van der Ven, Siebe G. Blok, Luciano C. P. Azevedo, Giacomo Bellani, Michela Botta, Elisa Estenssoro, Eddy Fan, Juliana Carvalho Ferreira, John G. Laffey, Ignacio Martín‐Loeches, Ana Motos, Tài Pham, Óscar Peñuelas, Antonio Artigas, Luigi Pisani, Ary Serpa Neto, Marcus J. Schultz, Antoni Torres, Anissa M. Tsonas, Frederique Paulus, David M. P. van Meenen, and for the ERICC–, Amadeu Martinez, Livia Leal, Antonio Jorge Pereira, Marcelo de Oliveira Maia, Josè Aires Neto, Claudio Piras, Eliana Bernadete Caser, Cora Lavigne Moreira, Pablo Braga Gusman, Dyanne Moysés Dalcomune, Alexandre Guilherme Ribeiro de Carvalho, Louise Aline Romão Gondim, Lívia Mariane Castelo Branco Reis, Daniel da Cunha Ribeiro, Leonardo de Assis Simões, Rafaela Siqueira Campos, José Carlos Fernandez Versiani dos Anjos, Frederico Bruzzi Carvalho, Rossine Ambrosio Alves, Lilian Batista Nunes, Álvaro Réa-Neto, Mirella Cristine de Oliveira, Luana Tannous, Brenno Cardoso Gomes, Fernando Borges Rodriguez, Priscila Abelha, Marcelo E Lugarinho, Andre Japiassu, Hélder Konrad de Melo, Elton Afonso Lopes, Pedro Varaschin, Vicente Cés de Souza Dantas, Marcos Freitas Knibel, Micheli Ponte, Pedro Mendes de Azambuja Rodrigues, Rubens Carmo Costa Filho, Felipe Saddy, Théia Forny Wanderley Castellões, Suzana Alves Silva, Luiz Antonio Gomes Osorio, Dora Mannarino, Rodolfo Espinoza, Cassia Righy, Marcio Soares, Jorge Salluh, Lilian Tanaka, Daniel Aragão, Maria Eduarda Tavares, Maura Goncalves Pereira Kehdi, Valéria Maria Campos Rezende, Roberto Carlos Cruz Carbonell, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Juçara Gasparetto Maccari, Priscylla Souza Castro, Paula Berto, Patricia Schwarz, André Peretti Torelly, Thiago Lisboa, Edison Moraes, Felipe Dal-Pizzol, Cristiane Tomasi Damiani, Cristiane Ritter, Juliana Carvalho Ferreira, Ramon Teixeira Costa, Pedro Caruso, Cristina Prata Amendola, Amanda Maria RR de Oliveira, Ulysses VA Silva, Luciana Coelho Sanches, Rosana DS Almeida, Luciano Cesar Azevedo, Marcelo Park, Guilherme Schettino, Murillo Santucci Assunção, Eliezer Silva, Carlos Eduardo Barboza, Antonio Paulo Nassar Junior
Abstract
Abstract Background Ventilation management may differ between COVID–19 ARDS (COVID–ARDS) patients and patients with pre–COVID ARDS (CLASSIC–ARDS); it is uncertain whether associations of ventilation management with outcomes for CLASSIC–ARDS also exist in COVID–ARDS. Methods Individual patient data analysis of COVID–ARDS and CLASSIC–ARDS patients in six observational studies of ventilation, four in the COVID–19 pandemic and two pre–pandemic. Descriptive statistics were used to compare epidemiology and ventilation characteristics. The primary endpoint were key ventilation parameters; other outcomes included mortality and ventilator–free days and alive (VFD–60) at day 60. Results This analysis included 6702 COVID–ARDS patients and 1415 CLASSIC–ARDS patients. COVID–ARDS patients received lower median V T (6.6 [6.0 to 7.4] vs 7.3 [6.4 to 8.5] ml/kg PBW; p < 0.001) and higher median PEEP (12.0 [10.0 to 14.0] vs 8.0 [6.0 to 10.0] cm H 2 O; p < 0.001), at lower median ΔP (13.0 [10.0 to 15.0] vs 16.0 [IQR 12.0 to 20.0] cm H 2 O; p < 0.001) and higher median Crs (33.5 [26.6 to 42.1] vs 28.1 [21.6 to 38.4] mL/cm H 2 O; p < 0.001). Following multivariable adjustment, higher ΔP had an independent association with higher 60–day mortality and less VFD–60 in both groups. Higher PEEP had an association with less VFD–60, but only in COVID–ARDS patients. Conclusions Our findings show important differences in key ventilation parameters and associations thereof with outcomes between COVID–ARDS and CLASSIC–ARDS. Trial registration Clinicaltrials.gov (identifier NCT05650957), December 14, 2022.