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- Title
Respiratory mechanics in late COVID-19 ARDS -- a restrictive pattern is strongly associated with death. A cohort study.
- Authors
Pestaña, David; Villar, Luisa Maria; Gomez-Rojo, Maria; Roy, Garbiñe; Olmedillo, Borja Hinojal; Giménez, Claudia; Zambrana, Paloma; Guisado, Gloria; Aláez, Azucena; Bardi, Tommaso
- Abstract
Background: COVID-19 is associated with severe respiratory distress and high mortality. We investigated the evolution of the respiratory mechanics in COVID-19 acute respiratory distress syndrome (ARDS) and the occurrence of a restrictive respiratory pattern. Methods: A retrospective, single-centre study including patients admitted to the ICU during the first wave of the pandemic (March-April 2020). Results: A total of 141 consecutive patients were included. Many patients developed a restrictive pattern of respiratory mechanics during the course of the disease. Fifty-two patients died in the hospital (36.8%). In 29 cases (58% of the deceased) death was associated with a pattern of pulmonary mechanics, indicating a restrictive evolution of ARDS. Other diagnoses related to death were pulmonary embolism (n = 7, 14%), septic shock (n = 17, 33%), and other causes (n = 10, 20%), with some patients combining at least 2 of these diagnoses. In a multivariate analysis, age (OR = 1.06; 95% CI: 1.01--1.12; P = 0.029) and the administration of steroid pulses (OR = 2.7; 95% CI: 1.1--6.8; P = 0.03) were associated with the development of a restrictive pulmonary pattern and a higher level of plasmatic interleukin-6. Conclusions: COVID-19 ARDS is associated with high mortality associated with a specific pattern of respiratory mechanics and sustained activation of innate immunological response. Age and administration of high-dose steroid pulses are associated with this clinical picture.
- Subjects
CAUSES of death; INTERLEUKINS; COVID-19; CONFIDENCE intervals; AGE distribution; STEROIDS; MULTIVARIATE analysis; RETROSPECTIVE studies; ADULT respiratory distress syndrome; DESCRIPTIVE statistics; ODDS ratio; RESPIRATORY mechanics; LONGITUDINAL method
- Publication
Anaesthesiology Intensive Therapy / Anestezjologia, Intensywna Terapia, 2022, Vol 54, Issue 4, p295
- ISSN
1642-5758
- Publication type
Article
- DOI
10.5114/ait.2022.121091