An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

Gianluigi Li Bassi; Jacky Y. Suen; Heidi J. Dalton; Nicole White; Sally Shrapnel; Jonathon P. Fanning; Benoit Liquet; Samuel Hinton; Aapeli Vuorinen; Gareth Booth; Jonathan E. Millar; Simon Forsyth; Mauro Panigada; John Laffey; Daniel Brodie; Eddy Fan; Antoni Torres; Davide Chiumello; Amanda Corley; Alyaa Elhazmi; Carol Hodgson; Shingo Ichiba; Carlos Luna; Srinivas Murthy; Alistair Nichol; Pauline Yeung Ng; Mark Ogino; Antonio Pesenti; Huynh Trung Trieu; John F. Fraser; the COVID-19 Critical Care Consortium

doi:10.1186/s13054-021-03518-4

An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

Gianluigi Li Bassi^*, Jacky Y. Suen, Heidi J. Dalton, Nicole White, Sally Shrapnel, Jonathon P. Fanning, Benoit Liquet, Samuel Hinton, Aapeli Vuorinen, Gareth Booth, Jonathan E. Millar, Simon Forsyth, Mauro Panigada, John Laffey, Daniel Brodie, Eddy Fan, Antoni Torres, Davide Chiumello, Amanda Corley, Alyaa ElhazmiCarol Hodgson, Shingo Ichiba, Carlos Luna, Srinivas Murthy, Alistair Nichol, Pauline Yeung Ng, Mark Ogino, Antonio Pesenti, Huynh Trung Trieu, John F. Fraser, the COVID-19 Critical Care Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

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Abstract

Background: Heterogeneous respiratory system static compliance (C_RS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.

Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe C_RS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.

Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of C_RS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). C_RS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO₂/FiO₂ (p = 0.100). Females presented lower C_RS than males (95% CI of C_RS difference between females-males: − 11.8 to − 7.4 mL/cmH₂O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with C_RS was marginal (p = 0.139). Ventilatory management varied across C_RS range, resulting in a significant association between C_RS and driving pressure (estimated decrease − 0.31 cmH₂O/L per mL/cmH₂0 of C_RS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that C_RS (+ 10 mL/cm H₂O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018).

Conclusions: This multicentre report provides a comprehensive account of C_RS in COVID-19 patients on MV. C_RS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study.

Trial registration: ACTRN12620000421932.

Original language	English
Article number	199
Pages (from-to)	1-22
Number of pages	22
Journal	Critical Care
Volume	25
DOIs	https://doi.org/10.1186/s13054-021-03518-4
Publication status	Published - 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Mechanical ventilation
Compliance
ARDS
COVID-19
SARS-CoV-2

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10.1186/s13054-021-03518-4Licence: CC BY

Publisher version (open access)Final published version, 1.02 MBLicence: CC BY

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Li Bassi, G., Suen, J. Y., Dalton, H. J., White, N., Shrapnel, S., Fanning, J. P., Liquet, B., Hinton, S., Vuorinen, A., Booth, G., Millar, J. E., Forsyth, S., Panigada, M., Laffey, J., Brodie, D., Fan, E., Torres, A., Chiumello, D., Corley, A., ... the COVID-19 Critical Care Consortium (2021). An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients. Critical Care, 25, 1-22. Article 199. https://doi.org/10.1186/s13054-021-03518-4

@article{4d8a6bd21c4545ae83aa5e009901af90,

title = "An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients",

abstract = "Background: Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: − 11.8 to − 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease − 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018). Conclusions: This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study. Trial registration: ACTRN12620000421932.",

keywords = "Mechanical ventilation, Compliance, ARDS, COVID-19, SARS-CoV-2",

author = "{Li Bassi}, Gianluigi and Suen, {Jacky Y.} and Dalton, {Heidi J.} and Nicole White and Sally Shrapnel and Fanning, {Jonathon P.} and Benoit Liquet and Samuel Hinton and Aapeli Vuorinen and Gareth Booth and Millar, {Jonathan E.} and Simon Forsyth and Mauro Panigada and John Laffey and Daniel Brodie and Eddy Fan and Antoni Torres and Davide Chiumello and Amanda Corley and Alyaa Elhazmi and Carol Hodgson and Shingo Ichiba and Carlos Luna and Srinivas Murthy and Alistair Nichol and Ng, {Pauline Yeung} and Mark Ogino and Antonio Pesenti and Trieu, {Huynh Trung} and Fraser, {John F.} and {the COVID-19 Critical Care Consortium} and Tala Al-Dabbous and Huda Alfoudri and Mohammed Shamsah and Subbarao Elapavaluru and Ashley Berg and Christina Horn and Stephan Schroll and Jorge Velazco and Wanda Fikes and Ludmyla Ploskanych and Dan Meyer and Maysoon Shalabi-McGuire and Trent Witt and Ashley Ehlers and Lorenzo Grazioli and Grandin, {E. Wilson} and Jose Nunez and Tiago Reyes and Mark Joseph and Brook Mitchell and Martha Tenzer and Ryuzo Abe and Yosuke Hayashi and Cho, {Hwa Jin} and Jeong, {In Seok} and Nicolas Brozzi and Jaime Hernandez-Montfort and Omar Mehkri and Stuart Houltham and Jer{\'o}nimo Graf and Rodrigo Perez and Roderigo Diaz and Camila Delgado and Joyce Gonz{\'a}lez and Sanchez, {Maria Soledad} and Rinc{\'o}n, {Diego Fernando Bautista} and Duque, {Melissa Bustamante} and Yanten, {Angela Maria Marulanda} and Dan Brodie and Desy Rusmawatiningtyas and Gabrielle Ragazzo and Azhari Taufik and Margaretha Gunawan and Vera Irawany and Muhammad Rayhan and Wardoyo, {Elizabeth Yasmin} and Mauro Panigada and Silvia Coppola and Sebastiano Colombo and Giacomo Grasselli and Michela Leone and Alberto Zanella and Massimo Antonelli and Simone Carelli and Grieco, {Domenico L.} and Motohiro Asaki and Kota Hoshino and Leonardo Salazar and Laura Duarte and Joseph McCaffrey and Allison Bone and David Thomson and Christel Arnold-Day and Jerome Cupido and Zainap Fanie and Malcom Miller and Lisa Seymore and {van Straaten}, Dawid and Ibrahim Hassan and Hssain, {Ali Ait} and Jeffrey Aliudin and Alqahtani, {Al Reem} and Khoulod Mohamed and Ahmed Mohamed and Darwin Tan and Joy Villanueva and Ahmed Zaqout and Ethan Kurtzman and Arben Ademi and Ana Dobrita and Aoudi, {Khadija El} and Juliet Segura and Gezy Giwangkancana and Shinichiro Ohshimo and Koji Hoshino and Saito Hitoshi and Yuka Uchinami and Javier Osatnik and Anne Joosten and Antoni Torres and Ana Motos and Minlan Yang and Carlos Luna and Francisco Arancibia and Virginie Williams and Alexandre Noel and Nestor Luque and Trung, {Trieu Huynh} and Sophie Yacoub and Marina Fantini and Garc{\'i}a, {Ruth Noemi Jorge} and Alvarez, {Enrique Chicote} and Anna Greti and Oscar Lomeli and Adrian Ceccato and Angel Sanchez and Vazquez, {Ana Loza} and Ferran Roche-Campo and Divina Tuazon and Toni Duculan and Hiroaki Shimizu and Marcelo Amato and Luciana Cassimiro and Flavio Pola and Francis Ribeiro and Guilherme Fonseca and Heidi Dalton and Mehul Desai and Erik Osborn and Hala Deeb and Antonio Arcadipane and Claudia Bianco and Raffaele Cuffaro and Gennaro Martucci and Giovanna Occhipinti and Matteo Rossetti and Chiara Vitiello and Cho, {Sung Min} and Kate Calligy and Glenn Whitman and Hiroaki Shimizu and Naoki Moriyama and Kim, {Jae Burm} and Nobuya Kitamura and Takashi Shimazui and Abdullah Al-Hudaib and Alyaa Elhazmi and Johannes Gebauer and Toshiki Yokoyama and Abdulrahman Al-Fares and Esam Alamad and Fatma Alawadhi and Kalthoum Alawadi and Sarah Buabbas and Hiro Tanaka and Satoru Hashimoto and Masaki Yamazaki and Oh, {Tak Hyuck} and Mark Epler and Cathleen Forney and Jared Feister and Katherine Grobengieser and Louise Kruse and Joelle Williamson and Eric Gnall and Mara Caroline and Sasha Golden and Colleen Karaj and Sherry McDermott and Lynn Sher and Timothy Shapiro and Lisa Thome and Mark Vanderland and Mary Welch and Luca Brazzi and Tawnya Ogston and Dave Nagpal and Karlee Fischer and Roberto Lorusso and {de Piero}, Maria and Mariano Esperatti and Diarmuid O{\textquoteright}Briain and Carton, {Edmund G.} and Ayan Sen and Amanda Palacios and Deborah Rainey and Cassandra Seefeldt and Lucia Durham and Octavio Falcucci and Amanda Emmrich and Jennifer Guy and Carling Johns and Emily Neumann and Nina Buchtele and Michael Schwameis and Stecher, {Stephanie Susanne} and Delila Singh and Michaela Barnikel and Lukas Arenz and Akram Zaaqoq and Galloway, {Lan Anh} and Caitlin Merley and Marc Csete and Luisa Quesada and Isabela Saba and Daisuke Kasugai and Hiroaki Hiraiwa and Taku Tanaka and Eva Marwali and Yoel Purnama and Dewayanti, {Santi Rahayu} and Ardiyan and Debby Siagian and Chen, {Yih Sharng} and John Laffey and Bairbre McNicholas and David Cosgrave and Marlice VanDyk and Sarah MacDonald and Ian Seppelt and Indrek Ratsep and Hannah Johnson and Peter Barrett and Gavin Salt and George Ng and Lee, {Sang Min} and Timothy Smith and Rebecca Holt and Timothy Evans and Rebecca Rose",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2021",

doi = "10.1186/s13054-021-03518-4",

language = "English",

volume = "25",

pages = "1--22",

journal = "Critical Care",

issn = "1364-8535",

publisher = "Springer, Springer Nature",

}

Li Bassi, G, Suen, JY, Dalton, HJ, White, N, Shrapnel, S, Fanning, JP, Liquet, B, Hinton, S, Vuorinen, A, Booth, G, Millar, JE, Forsyth, S, Panigada, M, Laffey, J, Brodie, D, Fan, E, Torres, A, Chiumello, D, Corley, A, Elhazmi, A, Hodgson, C, Ichiba, S, Luna, C, Murthy, S, Nichol, A, Ng, PY, Ogino, M, Pesenti, A, Trieu, HT, Fraser, JF & the COVID-19 Critical Care Consortium 2021, 'An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients', Critical Care, vol. 25, 199, pp. 1-22. https://doi.org/10.1186/s13054-021-03518-4

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T1 - An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

AU - Li Bassi, Gianluigi

AU - Suen, Jacky Y.

AU - Dalton, Heidi J.

AU - White, Nicole

AU - Shrapnel, Sally

AU - Fanning, Jonathon P.

AU - Liquet, Benoit

AU - Hinton, Samuel

AU - Vuorinen, Aapeli

AU - Booth, Gareth

AU - Millar, Jonathan E.

AU - Forsyth, Simon

AU - Panigada, Mauro

AU - Laffey, John

AU - Brodie, Daniel

AU - Fan, Eddy

AU - Torres, Antoni

AU - Chiumello, Davide

AU - Corley, Amanda

AU - Elhazmi, Alyaa

AU - Hodgson, Carol

AU - Ichiba, Shingo

AU - Luna, Carlos

AU - Murthy, Srinivas

AU - Nichol, Alistair

AU - Ng, Pauline Yeung

AU - Ogino, Mark

AU - Pesenti, Antonio

AU - Trieu, Huynh Trung

AU - Fraser, John F.

AU - the COVID-19 Critical Care Consortium

AU - Al-Dabbous, Tala

AU - Alfoudri, Huda

AU - Shamsah, Mohammed

AU - Elapavaluru, Subbarao

AU - Berg, Ashley

AU - Horn, Christina

AU - Schroll, Stephan

AU - Velazco, Jorge

AU - Fikes, Wanda

AU - Ploskanych, Ludmyla

AU - Meyer, Dan

AU - Shalabi-McGuire, Maysoon

AU - Witt, Trent

AU - Ehlers, Ashley

AU - Grazioli, Lorenzo

AU - Grandin, E. Wilson

AU - Nunez, Jose

AU - Reyes, Tiago

AU - Joseph, Mark

AU - Mitchell, Brook

AU - Tenzer, Martha

AU - Abe, Ryuzo

AU - Hayashi, Yosuke

AU - Cho, Hwa Jin

AU - Jeong, In Seok

AU - Brozzi, Nicolas

AU - Hernandez-Montfort, Jaime

AU - Mehkri, Omar

AU - Houltham, Stuart

AU - Graf, Jerónimo

AU - Perez, Rodrigo

AU - Diaz, Roderigo

AU - Delgado, Camila

AU - González, Joyce

AU - Sanchez, Maria Soledad

AU - Rincón, Diego Fernando Bautista

AU - Duque, Melissa Bustamante

AU - Yanten, Angela Maria Marulanda

AU - Brodie, Dan

AU - Rusmawatiningtyas, Desy

AU - Ragazzo, Gabrielle

AU - Taufik, Azhari

AU - Gunawan, Margaretha

AU - Irawany, Vera

AU - Rayhan, Muhammad

AU - Wardoyo, Elizabeth Yasmin

AU - Panigada, Mauro

AU - Coppola, Silvia

AU - Colombo, Sebastiano

AU - Grasselli, Giacomo

AU - Leone, Michela

AU - Zanella, Alberto

AU - Antonelli, Massimo

AU - Carelli, Simone

AU - Grieco, Domenico L.

AU - Asaki, Motohiro

AU - Hoshino, Kota

AU - Salazar, Leonardo

AU - Duarte, Laura

AU - McCaffrey, Joseph

AU - Bone, Allison

AU - Thomson, David

AU - Arnold-Day, Christel

AU - Cupido, Jerome

AU - Fanie, Zainap

AU - Miller, Malcom

AU - Seymore, Lisa

AU - van Straaten, Dawid

AU - Hassan, Ibrahim

AU - Hssain, Ali Ait

AU - Aliudin, Jeffrey

AU - Alqahtani, Al Reem

AU - Mohamed, Khoulod

AU - Mohamed, Ahmed

AU - Tan, Darwin

AU - Villanueva, Joy

AU - Zaqout, Ahmed

AU - Kurtzman, Ethan

AU - Ademi, Arben

AU - Dobrita, Ana

AU - Aoudi, Khadija El

AU - Segura, Juliet

AU - Giwangkancana, Gezy

AU - Ohshimo, Shinichiro

AU - Hoshino, Koji

AU - Hitoshi, Saito

AU - Uchinami, Yuka

AU - Osatnik, Javier

AU - Joosten, Anne

AU - Torres, Antoni

AU - Motos, Ana

AU - Yang, Minlan

AU - Luna, Carlos

AU - Arancibia, Francisco

AU - Williams, Virginie

AU - Noel, Alexandre

AU - Luque, Nestor

AU - Trung, Trieu Huynh

AU - Yacoub, Sophie

AU - Fantini, Marina

AU - García, Ruth Noemi Jorge

AU - Alvarez, Enrique Chicote

AU - Greti, Anna

AU - Lomeli, Oscar

AU - Ceccato, Adrian

AU - Sanchez, Angel

AU - Vazquez, Ana Loza

AU - Roche-Campo, Ferran

AU - Tuazon, Divina

AU - Duculan, Toni

AU - Shimizu, Hiroaki

AU - Amato, Marcelo

AU - Cassimiro, Luciana

AU - Pola, Flavio

AU - Ribeiro, Francis

AU - Fonseca, Guilherme

AU - Dalton, Heidi

AU - Desai, Mehul

AU - Osborn, Erik

AU - Deeb, Hala

AU - Arcadipane, Antonio

AU - Bianco, Claudia

AU - Cuffaro, Raffaele

AU - Martucci, Gennaro

AU - Occhipinti, Giovanna

AU - Rossetti, Matteo

AU - Vitiello, Chiara

AU - Cho, Sung Min

AU - Calligy, Kate

AU - Whitman, Glenn

AU - Shimizu, Hiroaki

AU - Moriyama, Naoki

AU - Kim, Jae Burm

AU - Kitamura, Nobuya

AU - Shimazui, Takashi

AU - Al-Hudaib, Abdullah

AU - Elhazmi, Alyaa

AU - Gebauer, Johannes

AU - Yokoyama, Toshiki

AU - Al-Fares, Abdulrahman

AU - Alamad, Esam

AU - Alawadhi, Fatma

AU - Alawadi, Kalthoum

AU - Buabbas, Sarah

AU - Tanaka, Hiro

AU - Hashimoto, Satoru

AU - Yamazaki, Masaki

AU - Oh, Tak Hyuck

AU - Epler, Mark

AU - Forney, Cathleen

AU - Feister, Jared

AU - Grobengieser, Katherine

AU - Kruse, Louise

AU - Williamson, Joelle

AU - Gnall, Eric

AU - Caroline, Mara

AU - Golden, Sasha

AU - Karaj, Colleen

AU - McDermott, Sherry

AU - Sher, Lynn

AU - Shapiro, Timothy

AU - Thome, Lisa

AU - Vanderland, Mark

AU - Welch, Mary

AU - Brazzi, Luca

AU - Ogston, Tawnya

AU - Nagpal, Dave

AU - Fischer, Karlee

AU - Lorusso, Roberto

AU - de Piero, Maria

AU - Esperatti, Mariano

AU - O’Briain, Diarmuid

AU - Carton, Edmund G.

AU - Sen, Ayan

AU - Palacios, Amanda

AU - Rainey, Deborah

AU - Seefeldt, Cassandra

AU - Durham, Lucia

AU - Falcucci, Octavio

AU - Emmrich, Amanda

AU - Guy, Jennifer

AU - Johns, Carling

AU - Neumann, Emily

AU - Buchtele, Nina

AU - Schwameis, Michael

AU - Stecher, Stephanie Susanne

AU - Singh, Delila

AU - Barnikel, Michaela

AU - Arenz, Lukas

AU - Zaaqoq, Akram

AU - Galloway, Lan Anh

AU - Merley, Caitlin

AU - Csete, Marc

AU - Quesada, Luisa

AU - Saba, Isabela

AU - Kasugai, Daisuke

AU - Hiraiwa, Hiroaki

AU - Tanaka, Taku

AU - Marwali, Eva

AU - Purnama, Yoel

AU - Dewayanti, Santi Rahayu

AU - Ardiyan,

AU - Siagian, Debby

AU - Chen, Yih Sharng

AU - Laffey, John

AU - McNicholas, Bairbre

AU - Cosgrave, David

AU - VanDyk, Marlice

AU - MacDonald, Sarah

AU - Seppelt, Ian

AU - Ratsep, Indrek

AU - Johnson, Hannah

AU - Barrett, Peter

AU - Salt, Gavin

AU - Ng, George

AU - Lee, Sang Min

AU - Smith, Timothy

AU - Holt, Rebecca

AU - Evans, Timothy

AU - Rose, Rebecca

N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2021

Y1 - 2021

N2 - Background: Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: − 11.8 to − 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease − 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018). Conclusions: This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study. Trial registration: ACTRN12620000421932.

AB - Background: Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: − 11.8 to − 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease − 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018). Conclusions: This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study. Trial registration: ACTRN12620000421932.

KW - Mechanical ventilation

KW - Compliance

KW - ARDS

KW - COVID-19

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85107601543&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/arc/CE170100009

U2 - 10.1186/s13054-021-03518-4

DO - 10.1186/s13054-021-03518-4

M3 - Article

C2 - 34108029

AN - SCOPUS:85107601543

SN - 1364-8535

VL - 25

SP - 1

EP - 22

JO - Critical Care

JF - Critical Care

M1 - 199

ER -

An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients

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