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

11 Citations (Scopus)

24 Downloads (Pure)

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

Cite this

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. [199]. https://doi.org/10.1186/s13054-021-03518-4

Li Bassi, Gianluigi ; Suen, Jacky Y. ; Dalton, Heidi J. ; White, Nicole ; Shrapnel, Sally ; Fanning, Jonathon P. ; Liquet, Benoit ; Hinton, Samuel ; Vuorinen, Aapeli ; Booth, Gareth ; Millar, Jonathan E. ; Forsyth, Simon ; Panigada, Mauro ; Laffey, John ; Brodie, Daniel ; Fan, Eddy ; Torres, Antoni ; Chiumello, Davide ; Corley, Amanda ; Elhazmi, Alyaa ; Hodgson, Carol ; Ichiba, Shingo ; Luna, Carlos ; Murthy, Srinivas ; Nichol, Alistair ; Ng, Pauline Yeung ; Ogino, Mark ; Pesenti, Antonio ; Trieu, Huynh Trung ; Fraser, John F. ; the COVID-19 Critical Care Consortium. / An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients. In: Critical Care. 2021 ; Vol. 25. pp. 1-22.

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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",

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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 (London, England)",

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

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

In: Critical Care, Vol. 25, 199, 2021, p. 1-22.

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

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AU - Suen, Jacky Y.

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AU - Fanning, Jonathon P.

AU - Liquet, Benoit

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AU - Fan, Eddy

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AU - Pesenti, Antonio

AU - Trieu, Huynh Trung

AU - Fraser, John F.

AU - the COVID-19 Critical Care Consortium

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AU - Alfoudri, Huda

AU - Shamsah, Mohammed

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AU - Berg, Ashley

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AU - Velazco, Jorge

AU - Fikes, Wanda

AU - Ploskanych, Ludmyla

AU - Meyer, Dan

AU - Shalabi-McGuire, Maysoon

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AU - Zaqout, Ahmed

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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

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U2 - 10.1186/s13054-021-03518-4

DO - 10.1186/s13054-021-03518-4

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C2 - 34108029

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JO - Critical care (London, England)

JF - Critical care (London, England)

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M1 - 199

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

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