The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients
Antoni Torres, Ana Motos, Jordi Riera, Laia Fernández‐Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Óscar Peñuelas, José Ángel Lorente, Alejandro Rodríguez, David de Gonzalo‐Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martín, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortíz, Elena Bustamante‐Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán‐Malagón, Víctor D. Gumucio-Sanguino, María del Carmen de la Torre, Emili Dı́az, Ángel Estella, Elena Gallego, J.L. García Garmendia, José Garnacho‐Montero, José María Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marín‐Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socías, Jordi Solé‐Violán, Fernando Suárez-Sipmann, Luis Tamayo Lomas, José Trenado, Ferrán Barbé, CIBERESUCICOVID Project (COV20/00110, ISCIII), Berta Adell-Serrano, Alexander Agrifoglio, María Aguilar Cabello, Luciano Aguilera, Victoria Alcaraz-Serrano, César Aldecoa, Cynthia Alegre, Sergio Álvarez, Antonjo Álvarez Ruiz, Rut Andrea, José Ángel, Marta Arrieta, Ignacio Ayestarán, Joan R. Badia, Mariona Badía, Orville Báez Pravia, Ana Balan Mariño, Begoña Balsera, Laura Barbena, Enric Barbeta, Tommaso Bardi, Patricia Barral Segade, Marta Barroso, José Ángel Berezo García, Judit Bigas, Rafael Blancas, María Luisa Blasco, María Victoria Boado, María Bodi Saera, Neus Bofill, María Teresa Bouza Vieiro, Leticia Bueno, Juan Bustamante‐Munguira, Lucia Cachafeiro, David Campi Hermoso, Sandra Campos Fernández, Iosune Cano, María Luisa Cantón‐Bulnes, Pablo Cardina Fernández, Laura Carrión García, Sula Carvalho, Núria Casacuberta-Barberà, Manuel Castellà
Abstract
Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO 2 /FiO 2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO 2 /FiO 2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO 2 /FiO 2 variation.