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- COVID-19
- SARS-CoV-2
- ARDS
- pulmonary artery catheter
- intrapulmonary shunt ratio
- recruitment-to-inflation ratio.
Introduction
Early in the COVID-19 pandemic, the scientific community questioned whether this infection led to typical ARDS or not. Gattinoni et al1 proposed a subdivision of COVID-19 ARDS into 2 phenotypes: L for low elastance, ventilation-perfusion ratio, lung weight, and recruitability; and H for high elastance, right-to-left shunt, lung weight, and recruitability. However, numerous studies failed to confirm these findings, leading authors to contest this classification.2 Nevertheless, the correct identification of the respiratory phenotype of COVID-19 ARDS seems of critical importance. Indeed, the use of high PEEP is expected to be beneficial in phenotype H, whereas a deleterious effect is expected in phenotype L. We conducted a study to describe early respiratory and hemodynamic modifications in response to high PEEP in subjects with COVID-19, using a pulmonary artery catheter for intrapulmonary shunt (Q̇S/Q̇T) determination and the recruitment-to-inflation (R/I) ratio to assess the lung recruitment potential. The primary objective of the study was to assess the effect of high PEEP on Q̇S/Q̇T in comparison with low PEEP. Secondary objectives were to evaluate whether high R/I correlated with a drop in Q̇S/Q̇T with low versus high PEEP and to describe advanced physiologic variables at each PEEP.
Methods
We prospectively included 15 subjects diagnosed with SARS-CoV-2–induced ARDS hospitalized between April 20, 2020–November 2, 2020. SARS-CoV-2 infection was confirmed by real-time reverse transcriptase-polymerase chain reaction assay of nasal swabs or lower respiratory tract samples. Subjects or their surrogates received oral and written information at ICU admission or prior to invasive mechanical ventilation. Written informed consent was waived. French institutional authority for personal data protection (National Commission for Information Technology and Freedom, registration number DEC20-102) and ethics committee (ID-CRB 2020-A00957-32, ref 2020/32) approved the study.
Inclusion criteria were (1) subjects intubated for < 72 h at …
Correspondence: Alexandre Gaudet MD PhD, Pôle de Réanimation, Hôpital Roger Salengro, Rue Emile Laine, CHU Lille, 59037 Lille cedex, France. E-mail: alexandre.gaudet{at}chru-lille.fr
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