The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

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. Mul...

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Autores: Torres, Antoni|||0000-0002-8643-2167, Motos, Ana|||0000-0002-3757-1232, Riera del Brio, Jordi|||0000-0002-1738-4448, Fernández Barat, Laia|||0000-0001-7528-9636, Ceccato, Adrian|||0000-0001-9454-062X, Pérez-Arnal, Raquel|||0000-0002-0041-8146, Garcia-Gasulla, Dario|||0000-0001-6732-5641, Peñuelas, Oscar|||0000-0003-1484-3933, Lorente, José Angel, Rodríguez, Alejandro, Gonzalo Calvo, David de|||0000-0003-2240-3532, Almansa, Raquel, Gabarrús, Albert|||0000-0003-3492-1310, Menéndez, Rosario, Bermejo-Martin, Jesus F.|||0000-0002-7998-6268, Ferrer, Ricard|||0000-0002-4859-4747, Amaya-Villar, Rosario, Añón, José Manuel, Barberà, Carme, Barberán, José, Blandino Ortiz, Aaron|||0000-0002-3184-6418, Bustamante-Munguira, Elena, Caballero, Jesús|||0000-0001-9005-9687, Carbajales, Cristina|||0000-0002-4496-5336, Carbonell, Nieves|||0000-0002-9149-0310, Catalán-González, Mercedes, Galbán, Cristóbal, Gumucio-Sanguino, Víctor D., de la Torre, Maria Del Carmen, Díaz Santos, Emilio|||0000-0003-3637-3821, Estella, Ángel|||0000-0003-0665-557X, Gallego, Elena, García Garmendia, José Luis|||0000-0003-1443-9236, Garnacho Montero, José|||0000-0003-2542-7601, Gómez, José M., Huerta, Arturo|||0000-0002-6191-4143, Jorge García, Ruth Noemí, Loza-Vázquez, Ana, Marin-Corral, Judith|||0000-0003-1320-4427, Martínez de la Gándara, Amalia, Martínez Varela, Ignacio, López Messa, Juan, M. Albaiceta, Guillermo, Novo, Mariana Andrea, Peñasco, Yhivian, Pozo-Laderas, Juan Carlos, Ricart, Pilar|||0000-0003-0067-9132, Salvador-Adell, Inmaculada, Sánchez Miralles, Ángel, Sancho Chinesta, Susana, Socias, Lorenzo, Solé-Violan, Jordi, Suares Sipmann, Fernando, Tamayo Lomas, Luis, Trenado, José, Barbé, Ferran|||0000-0002-2340-8928
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:290157
Acceso en línea:https://ddd.uab.cat/record/290157
https://dx.doi.org/urn:doi:10.1186/s13054-021-03727-x
Access Level:acceso abierto
Palabra clave:Ventilatory ratio
Mechanical ventilation
COVID-19
SARS-CoV-2
Coronavirus
Descripción
Sumario: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. 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. 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/FiO 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/FiO variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). 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/FiO variation. The online version contains supplementary material available at 10.1186/s13054-021-03727-x.

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