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Vandenbunder, Benoit; Ehrmann, Stephan; Piagnerelli, Michael; Sauneuf, Bertrand; Serck, Nicolas; Soumagne, Thibaud; Textoris, Julien; Vinsonneau, Christophe; Aissaoui, Nadia; Blonz, Gauthier; Carbutti, Giuseppe; Courcelle, Romain; D'hondt, Alain; Gaudry, Stephane; Higny, Julien; Horlait, Geoffroy; Hraiech, Sami; Lefebvre, Laurent; Lejeune, Francois; Ly, Andre; Lascarrou, Jean-Baptiste; Grimaldi, David
Critical care (London, England), 02/2021, Volume: 25, Issue: 1Journal Article
Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. The mean Crs in 372 patients was 37.6 ± 13 mL/cmH O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO /FiO ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs OR 1.0 (CI 95% 0.98-1.02) neither Crs/IBW OR 0.63 (CI 95% 0.13-3.1) were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was OR 0.93 (CI 95% 0.88-0.99). In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH O vs 37.8 ± 11.4 mL/cmH O, p < 0.001). The decrease in Crs was not associated with day-28 outcome. In a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.
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