Abstract
Background: Before the pandemic of coronavirus disease (COVID-19), rapidly improving acute respiratory distress syndrome (ARDS), mostly defined by early extubation, had been recognized as an increasingly prevalent subphenotype (making up 15-24% of all ARDS cases), associated with good prognosis (10% mortality in ARDSNet trials). We attempted to determine the prevalence and prognosis of rapidly improving ARDS and of persistent severe ARDS related to COVID-19.
Methods: We included consecutive patients with COVID-19 receiving invasive mechanical ventilation in three intensive care units (ICU) during the second pandemic wave in Greece. We defined rapidly improving ARDS as extubation or a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO 2 :FiO 2 ) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO 2 :FiO 2 of equal to or less than 100 on the second day following intubation.
Results: A total of 280 intubated patients met criteria of ARDS with a median PaO 2 :FiO 2 of 125.0 (interquartile range 93.0-161.0) on day of intubation, and overall ICU-mortality of 52.5% (ranging from 24.3 to 66.9% across the three participating sites). Prevalence of rapidly improving ARDS was 3.9% (11 of 280 patients); no extubation occurred on the first day following intubation. ICU-mortality of patients with rapidly improving ARDS was 54.5%. This low prevalence and high mortality rate of rapidly improving ARDS were consistent across participating sites. Prevalence of persistent severe ARDS was 12.1% and corresponding mortality was 82.4%.
Conclusions: Rapidly improving ARDS was not prevalent and was not associated with good prognosis among patients with COVID-19. This is starkly different from what has been previously reported for patients with ARDS not related to COVID-19. Our results on both rapidly improving ARDS and persistent severe ARDS may contribute to our understanding of trajectory of ARDS and its association with prognosis in patients with COVID-19.
Keywords: Acute respiratory distress syndrome; Acute respiratory failure; Coronavirus; Pneumonia; Trajectory.
【저자키워드】 coronavirus, acute respiratory distress syndrome, Pneumonia, Acute respiratory failure, trajectory., 【초록키워드】 COVID-19, coronavirus disease, ARDS, pandemic, Mortality, Prognosis, intensive care unit, intubation, oxygen, ICU, Prevalence, Patient, Greece, trajectory, trials, association, acute respiratory distress, Invasive mechanical ventilation, distress, criteria, interquartile range, severe ARDS, syndrome, fraction, high mortality rate, prevalent, greater, defined, occurred, reported, receiving, median, less, determine, contribute, increasingly, consecutive patient, intubated patient, PaO, patients with ARDS, patients with COVID-19, with COVID-19, 【제목키워드】 acute respiratory distress, syndrome,