Respir Res . Rapidly improving acute respiratory distress syndrome in COVID-19: a multi-centre observational study

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Respir Res


. 2022 Apr 14;23(1):94.
doi: 10.1186/s12931-022-02015-8.
Rapidly improving acute respiratory distress syndrome in COVID-19: a multi-centre observational study


Evdokia Gavrielatou ¹ , Katerina Vaporidi ² , Vasiliki Tsolaki ³ , Nikos Tserlikakis ² , George E Zakynthinos ³ , Eleni Papoutsi ¹ , Aikaterini Maragkuti ¹ , Athina G Mantelou ¹ , Dimitrios Karayiannis ¹ , Zafeiria Mastora ¹ , Dimitris Georgopoulos ² , Epaminondas Zakynthinos ³ , Christina Routsi ¹ , Spyros G Zakynthinos ¹ , Edward J Schenck ⁴ , Anastasia Kotanidou ¹ , Ilias I Siempos ^{5 6}



Affiliations

• PMID: 35422037
• DOI: 10.1186/s12931-022-02015-8

Abstract

Background: Before the pandemic of coronavirus disease (COVID-19), rapidly improving acute respiratory distress syndrome (ARDS), mostly defined by early extubation, had been recognized as an increasingly prevalent subphenotype (making up 15-24% of all ARDS cases), associated with good prognosis (10% mortality in ARDSNet trials). We attempted to determine the prevalence and prognosis of rapidly improving ARDS and of persistent severe ARDS related to COVID-19.
Methods: We included consecutive patients with COVID-19 receiving invasive mechanical ventilation in three intensive care units (ICU) during the second pandemic wave in Greece. We defined rapidly improving ARDS as extubation or a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO₂:FiO₂) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO₂:FiO₂ of equal to or less than 100 on the second day following intubation.
Results: A total of 280 intubated patients met criteria of ARDS with a median PaO₂:FiO₂ of 125.0 (interquartile range 93.0-161.0) on day of intubation, and overall ICU-mortality of 52.5% (ranging from 24.3 to 66.9% across the three participating sites). Prevalence of rapidly improving ARDS was 3.9% (11 of 280 patients); no extubation occurred on the first day following intubation. ICU-mortality of patients with rapidly improving ARDS was 54.5%. This low prevalence and high mortality rate of rapidly improving ARDS were consistent across participating sites. Prevalence of persistent severe ARDS was 12.1% and corresponding mortality was 82.4%.
Conclusions: Rapidly improving ARDS was not prevalent and was not associated with good prognosis among patients with COVID-19. This is starkly different from what has been previously reported for patients with ARDS not related to COVID-19. Our results on both rapidly improving ARDS and persistent severe ARDS may contribute to our understanding of trajectory of ARDS and its association with prognosis in patients with COVID-19.

Keywords: Acute respiratory distress syndrome; Acute respiratory failure; Coronavirus; Pneumonia; Trajectory.