Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study.
Journal
The Lancet. Respiratory medicine
ISSN: 2213-2619
Titre abrégé: Lancet Respir Med
Pays: England
ID NLM: 101605555
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
10
06
2020
revised:
23
07
2020
accepted:
07
08
2020
pubmed:
31
8
2020
medline:
22
12
2020
entrez:
31
8
2020
Statut:
ppublish
Résumé
Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19. This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed. Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm H Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates. None.
Sections du résumé
BACKGROUND
Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19.
METHODS
This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed.
FINDINGS
Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm H
INTERPRETATION
Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates.
FUNDING
None.
Identifiants
pubmed: 32861276
pii: S2213-2600(20)30370-2
doi: 10.1016/S2213-2600(20)30370-2
pmc: PMC7834127
pii:
doi:
Substances chimiques
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1201-1208Investigateurs
Alfredo Lissoni
(A)
Nicola Rossi
(N)
Amedeo Guzzardella
(A)
Carlo Valsecchi
(C)
Fabiana Madotto
(F)
Francesca Bevilacqua
(F)
Marco Di Laudo
(M)
Lorenzo Querci
(L)
Carmen Seccafico
(C)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Références
Am J Respir Crit Care Med. 1995 Aug;152(2):531-7
pubmed: 7633703
N Engl J Med. 2000 May 4;342(18):1301-8
pubmed: 10793162
AJR Am J Roentgenol. 1987 Mar;148(3):501-8
pubmed: 3492876
N Engl J Med. 2020 Jul 9;383(2):120-128
pubmed: 32437596
N Engl J Med. 1977 Mar 3;296(9):476-80
pubmed: 834225
Intensive Care Med. 2020 Dec;46(12):2200-2211
pubmed: 32728965
Intensive Care Med. 2020 Jun;46(6):1099-1102
pubmed: 32291463
Am J Physiol Lung Cell Mol Physiol. 2003 Jul;285(1):L20-8
pubmed: 12730079
Eur Radiol. 2020 Dec;30(12):6770-6778
pubmed: 32591888
Curr Pharm Biotechnol. 2011 Sep;12(9):1481-96
pubmed: 21401517
Physiol Rev. 2020 Jul 1;100(3):1065-1075
pubmed: 32216698
Lancet. 2020 Jun 6;395(10239):1763-1770
pubmed: 32442528
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
J Thromb Haemost. 2020 Jun;18(6):1517-1519
pubmed: 32294295
Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300
pubmed: 32228035
Lancet Respir Med. 2020 May;8(5):433-434
pubmed: 32203709
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
JAMA. 2010 Mar 3;303(9):865-73
pubmed: 20197533
N Engl J Med. 2019 May 23;380(21):1997-2008
pubmed: 31112383
JAMA. 2016 Feb 23;315(8):788-800
pubmed: 26903337
Crit Care. 2020 Apr 16;24(1):154
pubmed: 32299472
JAMA. 2020 Apr 28;323(16):1612-1614
pubmed: 32191259
Ann Am Thorac Soc. 2020 Sep;17(9):1158-1161
pubmed: 32432896
Clin Infect Dis. 2011 Jan 15;52(2):e14-7
pubmed: 21288835
Chest. 2010 Feb;137(2):288-96
pubmed: 19858233
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
AJR Am J Roentgenol. 2014 Jan;202(1):65-73
pubmed: 24370130
Am J Respir Crit Care Med. 2019 Feb 1;199(3):333-341
pubmed: 30211618
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Am Rev Respir Dis. 1981 Nov;124(5):593-601
pubmed: 7305115
Lancet Respir Med. 2020 May;8(5):506-517
pubmed: 32272080
N Engl J Med. 2010 Sep 16;363(12):1107-16
pubmed: 20843245
JAMA. 2020 Jun 9;323(22):2329-2330
pubmed: 32329799
Br J Radiol. 2012 Jun;85(1014):758-64
pubmed: 22167514
Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):544-51
pubmed: 1892293
N Engl J Med. 2020 May 21;382(21):2012-2022
pubmed: 32227758
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
Am J Respir Crit Care Med. 2020 May 15;201(10):1294-1297
pubmed: 32200645