Respiratory Physiology of COVID-19 and Influenza Associated Acute Respiratory Distress Syndrome

<b<Background:</b< There is ongoing debate whether lung physiology of COVID-19-associated acute respiratory distress syndrome (ARDS) differs from ARDS of other origin. <b<Objective</b<: The aim of this study was to analyze and compare how critically ill patients with COVID-19 and Influenza A or B were ventilated in our tertiary care center with or without extracorporeal membrane oxygenation (ECMO). We ask if acute lung failure due to COVID-19 requires different intensive care management compared to conventional ARDS. <b<Methods</b<: 25 patients with COVID-19-associated ARDS were matched to a cohort of 25 Influenza patients treated in our center from 2011 to 2021. Subgroup analysis addressed whether patients on ECMO received different mechanical ventilation than patients without extracorporeal support. <b<Results</b<: Compared to Influenza-associated ARDS, COVID-19 patients had higher ventilatory system compliance (40.7 mL/mbar [31.8–46.7 mL/mbar] vs. 31.4 mL/mbar [13.7–42.8 mL/mbar], <i<p</i< = 0.198), higher ventilatory ratio (1.57 [1.31–1.84] vs. 0.91 [0.44–1.38], <i<p</i< = 0.006) and higher minute ventilation at the time of intubation (mean minute ventilation 10.7 L/min [7.2–12.2 L/min] for COVID-19 vs. 6.0 L/min [2.5–10.1 L/min] for Influenza, <i<p</i< = 0.013). There were no measurable differences in P/F ratio, positive end-expiratory pressure (PEEP) and driving pressures (ΔP). Respiratory system compliance deteriorated considerably in COVID-19 patients on ECMO during 2 weeks of mechanical ventilation (C<sub<rs</sub<, mean decrease over 2 weeks −23.87 mL/mbar ± 32.94 mL/mbar, <i<p</i< = 0.037) but not in ventilated Influenza patients on ECMO and less so in ventilated COVID-19 patients without ECMO. For COVID-19 patients, low driving pressures on ECMO were strongly correlated to a decline in compliance after 2 weeks (Pearson’s R 0.80, <i<p</i< = 0.058). Overall mortality was insignificantly lower for COVID-19 patients compared to Influenza patients (40% vs. 48%, <i<p</i< = 0.31). Outcome was insignificantly worse for patients requiring veno-venous ECMO in both groups (50% mortality for COVID-19 on ECMO vs. 27% without ECMO, <i<p</i< = 0.30/56% vs. 34% mortality for Influenza A/B with and without ECMO, <i<p</i< = 0.31). <b<Conclusion:</b< The pathophysiology of early COVID-19-associated ARDS differs from Influenza-associated acute lung failure by sustained respiratory mechanics during the early phase of ventilation. We question whether intubated COVID-19 patients on ECMO benefit from extremely low driving pressures, as this appears to accelerate derecruitment and consecutive loss of ventilatory system compliance..

Medienart:	E-Artikel

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	Zur Gesamtaufnahme - volume:11
Enthalten in:	Journal of Clinical Medicine - 11(2022), 21, p 6237

Sprache:	Englisch

Beteiligte Personen:	Niklas Kronibus [VerfasserIn] Frederik Seiler [VerfasserIn] Guy Danziger [VerfasserIn] Ralf M. Muellenbach [VerfasserIn] Christian Reyher [VerfasserIn] André P. Becker [VerfasserIn] Maren Kamphorst [VerfasserIn] Torben M. Rixecker [VerfasserIn] Carlos Metz [VerfasserIn] Robert Bals [VerfasserIn] Philipp M. Lepper [VerfasserIn] Sebastian Mang [VerfasserIn]

Links:	doi.org [kostenfrei] doaj.org [kostenfrei] www.mdpi.com [kostenfrei] Journal toc [kostenfrei]

Themen:	Acute respiratory distress syndrome (ARDS) Coronavirus-disease 2019 (COVID-19) Extracorporeal membrane oxygenation (ECMO) Influenza A/B Mechanical ventilation Medicine R

doi:	10.3390/jcm11216237

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PPN (Katalog-ID):	DOAJ020665946