Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts

E V Carvalho; S P S Pinto; E P Gomes; Ó Peñuelas; C G Stohler; G C Arantes; L L Carvalho; R M F Oliveira; P N Martins; M M Reboredo; B V Pinheiro

doi:10.1016/j.medine.2023.01.004

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts

Med Intensiva (Engl Ed). 2023 Aug;47(8):445-453. doi: 10.1016/j.medine.2023.01.004. Epub 2023 Jan 30.

Authors

Affiliations

¹ Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
² Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
³ Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
⁴ Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil. Electronic address: Bruno.Pinheiro@ebserh.gov.br.

PMID: 36813658
DOI: 10.1016/j.medine.2023.01.004

Abstract

Objective: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies.

Design: Multiple prospective cohort study.

Setting: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120).

Patients: ARDS patients under MV.

Interventions: None.

Main variables of interest: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH₂O; and driving pressure ≤15cmH₂O), adherence to each individual component of the protective MV, and the association between protective MV and mortality.

Results: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH₂O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality.

Conclusions: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

Keywords: Acute respiratory distress syndrome; Adherence ventilation; Adhesión a la ventilación; COVID-19; Driving pressure; Mechanical ventilation; Presión de distensión; Síndrome de dificultad respiratoria aguda; Ventilación mecánica.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
Humans
Prospective Studies
Respiration, Artificial / adverse effects
Respiratory Distress Syndrome* / etiology
Respiratory Distress Syndrome* / therapy
Tidal Volume