Progressive changes in pulmonary gas exchange during invasive respiratory support for COVID-19 associated acute respiratory failure: a retrospective study of the association with 90-day mortality

Ylva Konsberg*, Anders Åneman, Fredrik Olsen, Fredrik Hessulf, Bengt Nellgård, Mathias Hård af Segerstad, Keti Dalla

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Ratio of arterial pressure of oxygen and fraction of inspired oxygen (P/F ratio) together with the fractional dead space (Vd/Vt) provides a global assessment of pulmonary gas exchange. The aim of this study was to assess the potential value of these variables to prognosticate 90-day survival in patients with COVID-19 associated ARDS admitted to the Intensive Care Unit (ICU) for invasive ventilatory support. Methods: In this single-center observational, retrospective study, P/F ratios and Vd/Vt were assessed up to 4 weeks after ICU-admission. Measurements from the first 2 weeks were used to evaluate the predictive value of P/F ratio and Vd/Vt for 90-day mortality and reported by the adjusted hazard ratio (HR) and 95% confidence intervals [95%CI] by Cox proportional hazard regression. Results: Almost 20,000 blood gases in 130 patients were analyzed. The overall 90-day mortality was 30% and using the data from the first ICU week, the HR was 0.85 [0.77–0.94] for every 10 mmHg increase in P/F ratio and 1.61 [1.20–2.16] for every 0.1 increase in Vd/Vt. In the second week, the HR for 90-day mortality was 0.82 [0.75–0.89] for every 10 mmHg increase in P/F ratio and 1.97 [1.42–2.73] for every 0.1 increase in Vd/Vt. Conclusion: The progressive changes in P/F ratio and Vd/Vt in the first 2 weeks of invasive ventilatory support for COVID-19 ARDS were significant predictors for 90-day mortality.

Original languageEnglish
Pages (from-to)803-811
Number of pages9
JournalActa Anaesthesiologica Scandinavica
Volume68
Issue number6
DOIs
Publication statusPublished - Jul 2024
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2024. 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

  • ARDS
  • COVID-19
  • dead space ventilation
  • P/F ratio

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