Dead space estimates may not be independently associated with 28-day mortality in COVID-19 ARDS
Morales-Quinteros, Luis; Neto, Ary Serpa; Artigas, Antonio; Blanch, Lluis; Botta, Michela; Kaufman, David A; Schultz, Marcus J; Tsonas, Anissa M; Paulus, Frederique; Bos, Lieuwe D; PRoVENT-COVID Study Group
(2021) Critical care (London, England), volume 25, issue 1
(Article)
Abstract
BACKGROUND: Estimates for dead space ventilation 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, multicenter, retrospective observational study done at
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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 wasted ventilation in patients with COVID-19-related ARDS. RESULTS: A total of 927 consecutive patients admitted with COVID-19-related ARDS were included in this study. Estimations of wasted 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 with an increase in 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 dead space estimates 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. TRIAL REGISTRATION: ISRCTN04346342. Registered 15 April 2020. Retrospectively registered.
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Keywords: Adult, Biomarkers, COVID-19/complications, Female, Humans, Intensive Care Units, Male, Patient Acuity, Prognosis, ROC Curve, Respiration, Artificial, Respiratory Dead Space, Respiratory Distress Syndrome/etiology, Respiratory Function Tests, Respiratory Mechanics, Retrospective Studies, Acute respiratory distress syndrome, Ventilatory ratio, Mortality, Dead space, COVID-19, Prognostication, ARDS, Respiratory dead space, Critical Care and Intensive Care Medicine, Observational Study, Multicenter Study, Journal Article
ISSN: 1466-609X
Publisher: Springer Science + Business Media
Note: Funding Information: Author?s information : A complete list of members of the PRoVENT-COVID collaborative group is provided: STEERING COMMITTEE : (in alphabetic order) A.G. Algera, L.S. Boers; L.D.J. Bos; M. Botta; J. Pillay, D.A. Dongelmans, M.W. Hollmann; J. Horn; F. Paulus; A. Serpa Neto; M.J. Schultz; A.M. Tsonas, A.P. Vlaar. STUDY COORDINATORS : (in alphabetic order) M. Botta; A.M. Tsonas. Investigators : (in alphabetic order): J.P. van Akkeren; A.G. Algera; C.K. Algoe; R.B. van Amstel; Artigas A; O.L. Baur; P. van de Berg; A.E. van den Berg; D.C.J.J. Bergmans; D.I. van den Bersselaar; F.A. Bertens; A.J.G.H. Bindels; M.M. de Boer; S. den Boer; L.S. Boers; M. Bogerd; L.D.J. Bos; M. Botta; J.S. Breel; H. de Bruin; S. de Bruin; C.L. Bruna; L.A. Buiteman?Kruizinga; O. Cremer; R.M. Determann; W. Dieperink; D.A. Dongelmans; H.S. Franke; M.S. Galek?Aldridge; M.J. de Graaff; L.A. Hagens; J.J. Haringman; S.T. van der Heide; P.L.J. van der Heiden; N.F.L. Heijnen; S.J.P. Hiel; L.L. Hoeijmakers; L. Hol; M. W. Hollmann; M.E. Hoogendoorn; J. Horn; R. van der Horst; E.L.K. Ie; D. Ivanov; N.P. Juffermans; E. Kho; E.S. de Klerk; A.W.M.M Koopman-van Gemert; M. Koopmans; S. Kucukcelebi; M.A. Kuiper; D.W. de Lange; N. van Mourik; Morales-Quinteros L; S.G. Nijbroek; M. Onrust; E.A.N. Oostdijk; F. Paulus; C.J. Pennartz; J. Pillay; L. Pisani; I.M. Purmer; T.C.D. Rettig; J.P Roozeman; M.T.U. Schuijt; M.J. Schultz; A. Serpa Neto; M.E. Sleeswijk; M.R. Smit; P.E. Spronk; W. Stilma; A.C. Strang; A. M. Tsonas; P.R Tuinman; C.M.A. Valk; F.L. Veen-Schra; L.I. Veldhuis; P. van Velzen; W.H. van der Ven; A.P.J. Vlaar; P. van Vliet; P.H.J. van der Voort; L. van Welie; H.J.F.T. Wesselink; H.H. van der Wier-Lubbers; B. van Wijk; T. Winters; W.Y. Wong; A.R.H. van Zanten. Funding Information: Dr Bos receives funding from the Dutch lung foundation (longfonds), from the Innovative Medicine Initiative and from Amsterdam UMC via the AUMC fellowship. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: © 2021, The Author(s).
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