Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS
Annalisa Boscolo,
Nicolò Sella,
Giulia Lorenzoni,
Tommaso Pettenuzzo,
Laura Pasin,
Chiara Pretto,
Martina Tocco,
Enrico Tamburini,
Alessandro De Cassai,
Paolo Rosi,
Enrico Polati,
Katia Donadello,
Leonardo Gottin,
Silvia De Rosa,
Fabio Baratto,
Fabio Toffoletto,
V. Marco Ranieri,
Dario Gregori,
Paolo Navalesi,
COVID-19 VENETO ICU Network
Affiliations
Annalisa Boscolo
Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital
Nicolò Sella
Department of Medicine (DIMED), Padua University School of Medicine
Giulia Lorenzoni
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University School of Medicine
Tommaso Pettenuzzo
Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital
Laura Pasin
Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital
Chiara Pretto
Department of Medicine (DIMED), Padua University School of Medicine
Martina Tocco
Department of Medicine (DIMED), Padua University School of Medicine
Enrico Tamburini
Department of Medicine (DIMED), Padua University School of Medicine
Alessandro De Cassai
Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital
Paolo Rosi
Emergency Medical Services, Regional Department, AULSS 3
Enrico Polati
Anesthesia and Intensive Care Unit B, Verona University Hospital
Katia Donadello
Anesthesia and Intensive Care Unit B, Verona University Hospital
Leonardo Gottin
Anesthesia and Intensive Care Unit B, Verona University Hospital
Silvia De Rosa
Anesthesia and Critical Care Unit, San Bortolo Hospital
Fabio Baratto
Anesthesia and Intensive Care Unit, Ospedale Riuniti Padova Sud
Fabio Toffoletto
Anesthesia and Intensive Care Unit, Ospedali di San Donà di Piave e Jesolo
V. Marco Ranieri
Anesthesia and Intensive Care Medicine, Department of Medical and Surgical Science, Policlinico di Sant’Orsola, Alma Mater Studiorum-Università di Bologna
Dario Gregori
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University School of Medicine
Paolo Navalesi
Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital
Abstract Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th–April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06–1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55–1.52). Multivariable analysis confirmed these findings. Conclusions Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.
