The following is the summary of “Ventilatory Parameters Measured After One Week of Mechanical Ventilation and Survival in COVID-19–Related ARDS” published in the January 2023 issue of Respiratory Care in January 2023 by Leatherman, et al.
Predicting the outcome of COVID-19-related ARDS using ventilatory characteristics assessed shortly after the start of mechanical ventilation is challenging. Researchers anticipated that patients who survived and those who didn’t could have different ventilatory parameters after a week of mechanical breathing. Gas exchange and lung mechanics were evaluated on the day of intubation and after a week in 127 patients with COVID-related ARDS. PaO2/FIO2, ventilatory ratio (VR), respiratory system compliance (CRS), and a composite score determined by the following formula: (PaO2/FIO2/100) ×CRS/VR were the primary variables of interest.
In the intensive care unit, death was the main result. The results showed that out of 127 patients, 42 (33%) died while being treated in the intensive care unit, and 85 (67%) were able to be extubated. Both survivors and non-survivors had comparable PPaO2/FIO2, CRS, and composite scores on the day after intubation, but survivors had a lower VR. At 1 week, non-survivors exhibited a considerably higher VR (2.04± 0.76 vs 1.60 ±0.43, P<.001), lower CRS (27.4 ±6.4 mL/cm H2O vs 32.4 ±9.3 mL/cm H2O, P=.002).
Lower composite score (20.6 ± 11.9 vs 34.5 ± 18.6, P<.001), but no statistically significant difference in PaO2/FIO2 (137 ± 49 vs 155 ± 48, P=.08). After 1 week of MV, there were significant differences between MV survivors and MV non-survivors on metrics that represent dead space (VR), lung mechanics (CRS), and a combination score that includes PaO2/FIO2, VR, and CRS.