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Research ArticleOriginal Research

Respiratory Mechanics in a Cohort of Critically Ill Subjects With COVID-19 Infection

August Longino, Toni Riveros, Erik Risa, Chris Hebert, Joshua Krieger, Steven Coppess, Flynn McGuire, Pavan K Bhatraju, James Town and Nicholas J Johnson
Respiratory Care October 2021, 66 (10) 1601-1609; DOI: https://doi.org/10.4187/respcare.09064
August Longino
Division of General Internal Medicine, University of Colorado, Aurora, Colorado.
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  • For correspondence: [email protected]
Toni Riveros
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
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Erik Risa
School of Medicine, University of Washington Medical Center, Seattle, Washington.
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Chris Hebert
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
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Joshua Krieger
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
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Steven Coppess
Department of Emergency Medicine, University of Washington Medical Center, Seattle, Washington.
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Flynn McGuire
School of Medicine, University of Washington Medical Center, Seattle, Washington.
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Pavan K Bhatraju
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
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James Town
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
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Nicholas J Johnson
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
Department of Emergency Medicine, University of Washington Medical Center, Seattle, Washington.
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Abstract

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) often develop acute hypoxemic respiratory failure and receive invasive mechanical ventilation. Much remains unknown about their respiratory mechanics, including the trajectories of pulmonary compliance and Embedded Image/Embedded Image, the prognostic value of these parameters, and the effects of prone positioning. We described respiratory mechanics among subjects with COVID-19 who were intubated during the first month of hospitalization.

METHODS: We included patients with COVID-19 who were mechanically ventilated between February and May 2020. Daily values of pulmonary compliance, Embedded Image, Embedded Image, and the use of prone positioning were abstracted from electronic medical records. The trends were analyzed separately over days 1–10 and days 1–35 of intubation, stratified by prone positioning use, survival, and initial Embedded Image/Embedded Image.

RESULTS: Among 49 subjects on mechanical ventilation day 1, the mean compliance was 41 mL/cm H2O, decreasing to 25 mL/cm H2O by day 14, the median duration of mechanical ventilation. In contrast, the Embedded Image/Embedded Image on day 1 was similar to day 14. The overall mean compliance was greater among the non-survivors versus the survivors (27 mL/cm H2O vs 24 mL/cm H2O; P = .005), whereas Embedded Image/Embedded Image was higher among the survivors versus the non-survivors over days 1–10 (159 mm Hg vs 138 mm Hg; P = .002) and days 1–35 (175 mm Hg vs 153 mm Hg; P < .001). The subjects who underwent early prone positioning had lower compliance during days 1–10 (27 mL/cm H2O vs 33 mL/cm H2O; P < .001) and lower Embedded Image/Embedded Image values over days 1–10 (139.9 mm Hg vs 167.4 mm Hg; P < .001) versus those who did not undergo prone positioning. After day 21 of hospitalization, the average compliance of the subjects who had early prone positioning surpassed that of the subjects who did not have prone positioning.

CONCLUSIONS: Respiratory mechanics of the subjects with COVID-19 who were on mechanical ventilation were characterized by persistently low respiratory system compliance and Embedded Image/Embedded Image, similar to ARDS due to other etiologies. The Embedded Image/Embedded Image was more tightly associated with mortality than with compliance.

  • COVID-19
  • SARS-CoV-2
  • pneumonia
  • viral
  • hypoxemic respiratory failure
  • mechanical ventilation
  • prone positioning
  • pulmonary compliance
  • PaO2/FIO2/ ratio
  • oxygenation

Footnotes

  • Correspondence: August Longino MD. E-mail: August.Longino{at}cuanschutz.edu
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (10)
Respiratory Care
Vol. 66, Issue 10
1 Oct 2021
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Respiratory Mechanics in a Cohort of Critically Ill Subjects With COVID-19 Infection
August Longino, Toni Riveros, Erik Risa, Chris Hebert, Joshua Krieger, Steven Coppess, Flynn McGuire, Pavan K Bhatraju, James Town, Nicholas J Johnson
Respiratory Care Oct 2021, 66 (10) 1601-1609; DOI: 10.4187/respcare.09064

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Respiratory Mechanics in a Cohort of Critically Ill Subjects With COVID-19 Infection
August Longino, Toni Riveros, Erik Risa, Chris Hebert, Joshua Krieger, Steven Coppess, Flynn McGuire, Pavan K Bhatraju, James Town, Nicholas J Johnson
Respiratory Care Oct 2021, 66 (10) 1601-1609; DOI: 10.4187/respcare.09064
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Keywords

  • COVID-19
  • SARS-CoV-2
  • pneumonia
  • viral
  • hypoxemic respiratory failure
  • mechanical ventilation
  • prone positioning
  • pulmonary compliance
  • PaO2/FIO2/ ratio
  • oxygenation

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