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- Title
Comparing Clinical Features and Outcomes in Mechanically Ventilated Patients with COVID-19 and the Acute Respiratory Distress Syndrome.
- Authors
Sjoding, Michael W.; Admon, Andrew J.; Saha, Anjan K.; Kay, Stephen G.; Brown, Christopher A.; Co, Ivan; Claar, Dru; McSparron, Jakob I.; Dickson, Robert P.
- Abstract
<bold>Rationale: </bold>Patients with severe coronavirus disease 2019 (COVID-19) meet clinical criteria for the acute respiratory distress syndrome (ARDS), yet early reports suggested they differ physiologically and clinically from patients with non-COVID-19 ARDS, prompting treatment recommendations that deviate from standard evidence-based practices for ARDS.<bold>Objectives: </bold>To compare respiratory physiology, clinical outcomes, and extrapulmonary clinical features of severe COVID-19 with non-COVID ARDS.<bold>Methods: </bold>We performed a retrospective cohort study, comparing 130 consecutive mechanically ventilated patients with severe COVID-19 with 382 consecutive mechanically ventilated patients with non-COVID-19 ARDS. Initial respiratory physiology and 28-day outcomes were compared. Extrapulmonary manifestations (inflammation, extrapulmonary organ injury, and coagulation) were compared in an exploratory analysis.<bold>Results: </bold>Comparison of patients with COVID-19 and non-COVID-19 ARDS suggested small differences in respiratory compliance, ventilatory efficiency, and oxygenation. 28-day mortality was 30% in COVID-19 patients and 38% in non-COVID ARDS. In adjusted analysis, point estimates of differences in time-to-breathing-unassisted at 28 days (adjusted SHR 0.98 [95% CI 0.77-1.26]) and 28-day mortality (risk ratio = 1.01 [95% CI 0.72-1.42]) were small for COVID-19 vs. non-COVID ARDS, although the confidence intervals for these estimates include moderate differences. Patients with COVID-19 had lower neutrophil counts but did not differ in lymphocyte count or other measures of systemic inflammation.<bold>Conclusions: </bold>In this single center cohort, we found no evidence for large differences between COVID-19 and non-COVID ARDS. Many key clinical features of severe COVID-19 were similar to those of non-COVID-19 ARDS, including respiratory physiology and clinical outcomes, although our sample size precludes definitive conclusions. Further studies are needed to define COVID-19-specific pathophysiology before deviation from evidence-based treatment practices can be recommended.
- Publication
Annals of the American Thoracic Society, 2021, Vol 18, Issue 11, p1876
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.202008-1076OC