Longitudinal changes in compliance, oxygenation and ventilatory ratio in COVID-19 versus non-COVID-19 pulmonary acute respiratory distress syndrome

François Beloncle, Antoine Studer, Valérie Seegers, Jean-Christophe Richard, Christophe Desprez, Nicolas Fage, Hamid Merdji, Bertrand Pavlovsky, Julie Helms, Sibylle Cunat, Satar Mortaza, Julien Demiselle, Laurent Brochard, Alain Mercat, Ferhat Meziani, François Beloncle, Antoine Studer, Valérie Seegers, Jean-Christophe Richard, Christophe Desprez, Nicolas Fage, Hamid Merdji, Bertrand Pavlovsky, Julie Helms, Sibylle Cunat, Satar Mortaza, Julien Demiselle, Laurent Brochard, Alain Mercat, Ferhat Meziani

Abstract

Background: Differences in physiology of ARDS have been described between COVID-19 and non-COVID-19 patients. This study aimed to compare initial values and longitudinal changes in respiratory system compliance (CRS), oxygenation parameters and ventilatory ratio (VR) in patients with COVID-19 and non-COVID-19 pulmonary ARDS matched on oxygenation.

Methods: 135 patients with COVID-19 ARDS from two centers were included in a physiological study; 767 non-COVID-19 ARDS from a clinical trial were used for the purpose of at least 1:2 matching. A propensity-matching was based on age, severity score, oxygenation, positive end-expiratory pressure (PEEP) and pulmonary cause of ARDS and allowed to include 112 COVID-19 and 198 non-COVID pulmonary ARDS.

Results: The two groups were similar on initial oxygenation. COVID-19 patients had a higher body mass index, higher CRS at day 1 (median [IQR], 35 [28-44] vs 32 [26-38] ml cmH2O-1, p = 0.037). At day 1, CRS was correlated with oxygenation only in non-COVID-19 patients; 61.6% and 68.2% of COVID-19 and non-COVID-19 pulmonary ARDS were still ventilated at day 7 (p = 0.241). Oxygenation became lower in COVID-19 than in non-COVID-19 patients at days 3 and 7, while CRS became similar. VR was lower at day 1 in COVID-19 than in non-COVID-19 patients but increased from day 1 to 7 only in COVID-19 patients. VR was higher at days 1, 3 and 7 in the COVID-19 patients ventilated using heat and moisture exchangers compared to heated humidifiers. After adjustment on PaO2/FiO2, PEEP and humidification device, CRS and VR were found not different between COVID-19 and non-COVID-19 patients at day 7. Day-28 mortality did not differ between COVID-19 and non-COVID-19 patients (25.9% and 23.7%, respectively, p = 0.666).

Conclusions: For a similar initial oxygenation, COVID-19 ARDS initially differs from classical ARDS by a higher CRS, dissociated from oxygenation. CRS become similar for patients remaining on mechanical ventilation during the first week of evolution, but oxygenation becomes lower in COVID-19 patients.

Trial registration: clinicaltrials.gov NCT04385004.

Keywords: Acute Respiratory Distress Syndrome; Covid-19; Dead space; Mechanical ventilation; Respiratory failure; Respiratory mechanics.

Conflict of interest statement

FB reports personal fees from Löwenstein Medical and research support from Covidien, Getinge Group and GE Healthcare, outside this work. JCR reports part‐time salary for research activities from Air Liquide Medical Systems and Vygon and grants from Creative Air Liquide, outside this work. LB reports research grants and/or research support from Medtronic Covidien, Fisher Paykel, Philips, Sentec, Air Liquide Medical Systems and GE Healthcare, outside this work. AM reports personal fees from Faron Pharmaceuticals, Air Liquid Medical Systems, Pfizer, Resmed and Draeger and grants and personal fees from Fisher and Paykel and Covidien, outside this work. The other authors have no conflict of interest to declare.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Ratio of partial pressure of arterial oxygen (PaO2) over fraction of inspired oxygen (FiO2) (A), alveolar-arterial oxygen gradient (A-a O2 gradient) (B), compliance of the respiratory system (CRS) (C) and ventilatory ratio (D) in matched patients with COVID-19 and non-COVID-19 pulmonary acute respiratory distress syndrome at day 1, day 3 and day 7. Boxplots display medians, 10th, 25th, 75th, and 90th percentiles
Fig. 2
Fig. 2
Respective correlations between the ratio of partial pressure of arterial oxygen (PaO2) over fraction of inspired oxygen (FiO2) and the compliance of the respiratory system (CRS) at day 1 (A) and day 7 (B) in the matched patients with COVID-19 and non-COVID-19 pulmonary ARDS
Fig. 3
Fig. 3
Ventilatory ratio at day 1, day 3 and day 7 in patients with COVID-19-associated acute respiratory distress syndrome ventilated using a heat and moister exchanger or a heated humidifier. Boxplots display medians, 10th, 25th, 75th, and 90th percentiles

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