The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients.
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Torres Antoni, Motos Anna, Riera Jordi, Fernández-Barat Laia, Ceccato Adrián, Pérez-Arnal Raquel, García-Gasulla Dario, Peñuelas Oscar, Lorente José Angel, Rodriguez Alejandro, de Gonzalo-Calvo David, Almansa Raquel, Gabarrús Albert, Menéndez Rosario, Bermejo-Martin Jesús F, Ferrer Ricard, Amaya Villar Rosario, Añón José M, Barberà Carme, Barberán José, Blandino Ortiz Aaron, Bustamante-Munguira Elena, Caballero Jesús, Carbajales Cristina, Carbonell Nieves, Catalán-González Mercedes, Galbán Cristóbal, Gumucio-Sanguino Víctor D, de la Torre Maria Del Carmen, Díaz Emili, Estella Ángel, Gallego Elena, García Garmendia José Luis, Garnacho-Montero José, Gómez José M, Huerta Arturo, Jorge García Ruth Noemí, Loza-Vázquez Ana, Marin-Corral Judith, Martínez de la Gándara Amalia, Martínez Varela Ignacio, López Messa Juan, M Albaiceta Guillermo, Novo Mariana Andrea, Peñasco Yhivian, Pozo-Laderas Juan Carlos, Ricart Pilar, Salvador-Adell Inmaculada, Sánchez-Miralles Angel, Sancho Chinesta Susana, Socias Lorenzo, Solé-Violan Jordi, Suares Sipmann Fernando, Tamayo Lomas Luis, Trenado José, Barbé Ferran, CIBERESUCICOVID Project (COV20/00110, ISCIII)
Аннотация
METHODS: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.
RESULTS: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47).
CONCLUSIONS: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.