PT  - JOURNAL ARTICLE
AU  - Nikhil Jagan
AU  - Lee E. Morrow
AU  - Ryan W. Walters
AU  - Robert W. Plambeck
AU  - Ian Ng
AU  - Jasmin J. Chovatiya
AU  - Jeffrey C. Macaraeg
AU  - Karson F. Kalian
AU  - Zachariah L. Wittenberg
AU  - William M. Pruett
AU  - Jonathan Knedler
AU  - Lauren P. Klein
AU  - Pooja Kasinath
AU  - Emily D. Dyer
AU  - Adam A. Bergh
AU  - Mark A. Malesker
TI  - A retrospective analysis of the effects of TIME on Compliance and Driving pressures in acute respiratory distress syndrome: The TIMED study
AID  - 10.4187/respcare.10080
DP  - 2022 Jun 15
TA  - Respiratory Care
PG  - respcare.10080
4099  - http://rc.rcjournal.com/content/early/2022/06/15/respcare.10080.short
4100  - http://rc.rcjournal.com/content/early/2022/06/15/respcare.10080.full
AB  - Background: The evolution of compliance and driving pressure in acute respiratory distress syndrome (ARDS) and the effects of time spent on noninvasive respiratory support prior to intubation has not been well studied. We conducted this study to assess the effect of the duration of noninvasive respiratory support prior to intubation (i.e., Noninvasive ventilation (NIV), High flow nasal cannula (HFNC), or a combination of NIV and HFNC) on static compliance and driving pressure and retrospectively describe its trajectory over time for COVID-19 and non-COVID-19 ARDS while on mechanical ventilation.Methods: Retrospective analysis of prospectively collected data from one university-affiliated academic medical center, one a rural magnet hospital, and three suburban community facilities. A total of 589 patients were included: 55 COVID-19 positive, 137 culture positive, and 397 culture negative patients. Static compliance and driving pressure were calculated at each 8-hour ventilator check.Results: Days of pre-intubation noninvasive respiratory support was associated with worse compliance and driving pressure but did not moderate any trajectory. COVID-19 positive patients showed non-statistically significant worsening compliance by 0.08-units per ventilator check (p = .241), whereas COVID-19 negative patients who were either culture positive or negative patients showed statistically significant improvement (0.12 and 0.18, respectively; both p < .05); a statistically similar but inverse pattern was observed for driving pressure.Conclusion In contrast to non-COVID-19 ARDS, COVID-19 ARDS was associated with a more ominous trajectory with no improvement in static compliance or driving pressures. Though there was no association between days of pre-intubation noninvasive respiratory support and mortality, its use was associated with worse overall compliance and driving pressure.