First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, 45-47 Ipsilantou Street, 10676, Athens, Greece.
Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete, Heraklion, Greece.
Respir Res. 2022 Apr 14;23(1):94. doi: 10.1186/s12931-022-02015-8.
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.
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:FiO) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO:FiO of equal to or less than 100 on the second day following intubation.
A total of 280 intubated patients met criteria of ARDS with a median PaO:FiO 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%.
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.
在冠状病毒病（COVID-19）大流行之前，以早期拔管为特征的急性呼吸窘迫综合征（ARDS）迅速改善已被认为是一种越来越普遍的亚表型（占所有 ARDS 病例的 15-24%），预后良好（ARDSNet 试验中死亡率为 10%）。我们试图确定与 COVID-19 相关的迅速改善的 ARDS 和持续严重的 ARDS 的患病率和预后。
我们纳入了希腊第二次大流行期间在三个重症监护病房（ICU）接受有创机械通气的连续 COVID-19 患者。我们将迅速改善的 ARDS 定义为插管后第一天动脉血氧分压与吸入氧分数之比（PaO:FiO）大于 300 或拔管。我们将插管后第二天 PaO:FiO 等于或小于 100 定义为持续严重的 ARDS。
共有 280 例插管患者符合 ARDS 标准，插管当天 PaO:FiO 的中位数为 125.0（四分位间距 93.0-161.0），总体 ICU 死亡率为 52.5%（三个参与地点的死亡率范围为 24.3%至 66.9%）。迅速改善的 ARDS 的患病率为 3.9%（280 例患者中有 11 例）；第一天没有拔管。迅速改善的 ARDS 患者的 ICU 死亡率为 54.5%。这种迅速改善的 ARDS 的低患病率和高死亡率在参与的地点是一致的。持续严重的 ARDS 的患病率为 12.1%，相应的死亡率为 82.4%。
在 COVID-19 患者中，迅速改善的 ARDS 并不常见，也与良好的预后无关。这与以前报道的与 COVID-19 无关的 ARDS 患者的情况截然不同。我们关于迅速改善的 ARDS 和持续严重的 ARDS 的结果可能有助于我们了解 ARDS 的轨迹及其与 COVID-19 患者预后的关系。
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