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Research
Luis Morales-Quinteros
Sagrat Cor University Hospital: Hospital Universitari Sagrat Cor
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8937-9824
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Surrogates for impaired ventilation such as estimated dead-space fractions and the ventilatory ratio have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19 related ARDS.
Methods: Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicentre, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of impaired ventilation patients with COVID-19 related ARDS.
Results: 927 consecutive patients admitted with COVID-19 related ARDS were included in this study. Surrogates of impaired ventilation such as the estimated dead space fraction (by Harris-Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p <0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p<0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris-Benedict and by direct estimation, and for the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the surrogates of impaired ventilation measured at the start of ventilation or the following days were significantly associated with 28-day mortality.
Conclusions: There is significant impairment of ventilation in the early course of COVID-19 related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk-model.
Keywords
Acute respiratory distress syndrome, ARDS, Respiratory dead space, Dead space, Ventilatory ratio, COVID-19, Mortality, prognostication
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Title: Impaired ventilation is not associated with 28-day mortality in COVID-19 ARDS Description of data: methods, tables and figure
- Table1.docx
- Table2.docx
- Table3.docx
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Received 20 Mar, 2021
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On 18 Mar, 2021
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On 18 Mar, 2021
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On 18 Mar, 2021
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No community comments so far
Editorial decision: Major revision
On 25 Feb, 2021
Review #3 received
Received 23 Feb, 2021
Review #4 received
Received 16 Feb, 2021
Reviewer #4 agreed
On 06 Feb, 2021
Review #2 received
Received 04 Feb, 2021
Review #1 received
Received 03 Feb, 2021
Reviewer #2 agreed
On 31 Jan, 2021
Reviewer #3 agreed
On 31 Jan, 2021
Reviewer #1 agreed
On 27 Jan, 2021
Reviewers invited
Invitations sent on 26 Jan, 2021
Editor assigned
On 25 Jan, 2021
Editor invited
On 25 Jan, 2021
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On 19 Jan, 2021
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On 17 Jan, 2021
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Luis Morales-Quinteros
Sagrat Cor University Hospital: Hospital Universitari Sagrat Cor
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8937-9824
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 27 Mar, 2021
Editorial decision: Minor revision
On 27 Mar, 2021
Review #3 received
Received 24 Mar, 2021
Review #2 received
Received 21 Mar, 2021
Reviewer #4 agreed
On 20 Mar, 2021
Review #4 received
Received 20 Mar, 2021
Reviewer #2 agreed
On 18 Mar, 2021
Reviewer #3 agreed
On 18 Mar, 2021
Editor assigned
On 18 Mar, 2021
Reviewers invited
Invitations sent on 18 Mar, 2021
Reviewer #1 agreed
On 18 Mar, 2021
Review #1 received
Received 18 Mar, 2021
Submission checks complete
On 18 Mar, 2021
Editor invited
On 18 Mar, 2021
This version was not preprinted
Version 1
Posted 21 Jan, 2021
No community comments so far
Editorial decision: Major revision
On 25 Feb, 2021
Review #3 received
Received 23 Feb, 2021
Review #4 received
Received 16 Feb, 2021
Reviewer #4 agreed
On 06 Feb, 2021
Review #2 received
Received 04 Feb, 2021
Review #1 received
Received 03 Feb, 2021
Reviewer #2 agreed
On 31 Jan, 2021
Reviewer #3 agreed
On 31 Jan, 2021
Reviewer #1 agreed
On 27 Jan, 2021
Reviewers invited
Invitations sent on 26 Jan, 2021
Editor assigned
On 25 Jan, 2021
Editor invited
On 25 Jan, 2021
Submission checks complete
On 19 Jan, 2021
First submitted
On 17 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Surrogates for impaired ventilation such as estimated dead-space fractions and the ventilatory ratio have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19 related ARDS.
Methods: Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicentre, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of impaired ventilation patients with COVID-19 related ARDS.
Results: 927 consecutive patients admitted with COVID-19 related ARDS were included in this study. Surrogates of impaired ventilation such as the estimated dead space fraction (by Harris-Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p <0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p<0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris-Benedict and by direct estimation, and for the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the surrogates of impaired ventilation measured at the start of ventilation or the following days were significantly associated with 28-day mortality.
Conclusions: There is significant impairment of ventilation in the early course of COVID-19 related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk-model.
Figure 1
Figure 2
Figure 3
Figure 4
This preprint is available for download as a PDF.
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