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Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

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Maamar, Adel | Guillot, Pauline | Joussellin, Vincent | Delamaire, Flora | Painvin, Benoit | Bichon, Anaëlle | de la Jartre, Océane Bernard | Mauget, Matteo | Lesouhaitier, Mathieu | Tadie, Jean Marc | Terzi, Nicolas | Gacouin, Arnaud

Edité par CCSD ; European Respiratory Society -

International audience. BACKGROUND: This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P (aO(2)) )/inspiratory oxygen fraction (F (IO(2)) ) ≤150 mmHg. METHODS: We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C (rs)), ventilator ratio, corrected minute ventilation (V’(Ecorr)) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed. RESULTS: On day 1 of ARDS, COVID-19 patients had significantly higher P (aO(2)) /F (IO(2)) (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH(2)O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V’(Ecorr) (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min(-1); p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P (aO(2)) /F (IO(2)) , arterial carbon dioxide tension, ventilatory ratio and V’(Ecorr) differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43). CONCLUSIONS: Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.

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