Respiratory Research (Apr 2022)

Rapidly improving acute respiratory distress syndrome in COVID-19: a multi-centre observational study

  • Evdokia Gavrielatou,
  • Katerina Vaporidi,
  • Vasiliki Tsolaki,
  • Nikos Tserlikakis,
  • George E. Zakynthinos,
  • Eleni Papoutsi,
  • Aikaterini Maragkuti,
  • Athina G. Mantelou,
  • Dimitrios Karayiannis,
  • Zafeiria Mastora,
  • Dimitris Georgopoulos,
  • Epaminondas Zakynthinos,
  • Christina Routsi,
  • Spyros G. Zakynthinos,
  • Edward J. Schenck,
  • Anastasia Kotanidou,
  • Ilias I. Siempos

DOI
https://doi.org/10.1186/s12931-022-02015-8
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 12

Abstract

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Abstract Background 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. Methods 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 (PaO2:FiO2) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO2:FiO2 of equal to or less than 100 on the second day following intubation. Results A total of 280 intubated patients met criteria of ARDS with a median PaO2:FiO2 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%. Conclusions 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.

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