Corrected Minute Ventilation Is Associated With Mortality in ARDS Caused by COVID-19

Abstract

BACKGROUND: The ratio of dead space to tidal volume (V D /V T ) is associated with mortality in patients with ARDS. Corrected minute ventilation ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> ) is a simple surrogate of dead space, but, despite its increasing use, its association with mortality has not been proven. The aim of our study was to assess the association between <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> and hospital mortality. We also compared the strength of this association with that of estimated V D /V T and ventilatory ratio. METHODS: We performed a retrospective study with prospectively collected data. We evaluated 187 consecutive mechanically ventilated subjects with ARDS caused by novel coronavirus disease (COVID-19). The association between <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> and hospital mortality was assessed in multivariable logistic models. The same was done for estimated V D /V T and ventilatory ratio. RESULTS: Mean ± SD <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> was 11.8 ± 3.3 L/min in survivors and 14.5 ± 3.9 L/min in nonsurvivors ( P &lt; .001) and was independently associated with mortality (adjusted odds ratio 1.15, P = .01). The strength of association of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> with mortality was similar to that of V D /V T and ventilatory ratio. CONCLUSIONS: <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> was independently associated with hospital mortality in subjects with ARDS caused by COVID-19. <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mover accent="true"> <mml:mi mathvariant="bold">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">E</mml:mtext> <mml:mrow> <mml:mtext mathvariant="bold">corr</mml:mtext> </mml:mrow> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> could be used at the patient’s bedsid

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