tetano
Editor, Senior Moderator
Acute Crit Care
. 2021 Jul 30.
doi: 10.4266/acc.2021.00388. Online ahead of print.
Comparison of characteristics and ventilatory course between coronavirus disease 2019 and middle east respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid[SUP] 1 2 [/SUP], Romaysaa M Yamani[SUP] 2 [/SUP], Maryam Imran[SUP] 3 [/SUP], Muhammad Ali Akhtar[SUP] 2 [/SUP], Manahil Imran[SUP] 3 [/SUP], Rumaan Gul[SUP] 3 [/SUP], Tabindeh Jabeen Khalid[SUP] 2 [/SUP], Ghassan Y Wali[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Both coronavirus disease 2019 (COVID-19) and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERS patients with ARDS to evaluate this issue.
Methods: MERS patients with ARDS seen during the March to May 2014 outbreak and COVID-19 patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.
Results: Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO2, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were high and reflective of their baseline comorbid status.
Conclusion: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients might explain the greater steroid responsiveness in this population.
Keywords: COVID-19; acute respiratory distress syndrome; middle east respiratory syndrome coronavirus; mortality; outcome; ventilatory.
. 2021 Jul 30.
doi: 10.4266/acc.2021.00388. Online ahead of print.
Comparison of characteristics and ventilatory course between coronavirus disease 2019 and middle east respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid[SUP] 1 2 [/SUP], Romaysaa M Yamani[SUP] 2 [/SUP], Maryam Imran[SUP] 3 [/SUP], Muhammad Ali Akhtar[SUP] 2 [/SUP], Manahil Imran[SUP] 3 [/SUP], Rumaan Gul[SUP] 3 [/SUP], Tabindeh Jabeen Khalid[SUP] 2 [/SUP], Ghassan Y Wali[SUP] 2 [/SUP]
Affiliations
- PMID: 34325501
- DOI: 10.4266/acc.2021.00388
Abstract
Background: Both coronavirus disease 2019 (COVID-19) and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERS patients with ARDS to evaluate this issue.
Methods: MERS patients with ARDS seen during the March to May 2014 outbreak and COVID-19 patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.
Results: Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO2, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were high and reflective of their baseline comorbid status.
Conclusion: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients might explain the greater steroid responsiveness in this population.
Keywords: COVID-19; acute respiratory distress syndrome; middle east respiratory syndrome coronavirus; mortality; outcome; ventilatory.