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Observational Study
. 2021 Feb 8;25(1):52.
doi: 10.1186/s13054-020-03433-0.

Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study

Benoit Vandenbunder #  1 , Stephan Ehrmann #  2 , Michael Piagnerelli  3 , Bertrand Sauneuf  4 , Nicolas Serck  5 , Thibaud Soumagne  6 , Julien Textoris  7   8 , Christophe Vinsonneau  9 , Nadia Aissaoui  10 , Gauthier Blonz  11 , Giuseppe Carbutti  12 , Romain Courcelle  13 , Alain D'hondt  14 , Stephane Gaudry  15 , Julien Higny  16 , Geoffroy Horlait  17 , Sami Hraiech  18   19 , Laurent Lefebvre  20 , Francois Lejeune  21 , Andre Ly  22 , Jean-Baptiste Lascarrou #  23 , David Grimaldi #  24 ; COVADIS study group
Collaborators, Affiliations
Observational Study

Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study

Benoit Vandenbunder et al. Crit Care. .

Abstract

Background: Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14.

Methods: In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation.

Results: The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98-1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13-3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88-0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome.

Conclusion: In a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.

Keywords: ICU; Mechanical ventilation; Mortality; PEEP; Plateau pressure; Respiratory mechanics; SARS-COV-2.

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Conflict of interest statement

JT is a part-time employee of bioMérieux, an IVD company, and Hospices Civils de Lyon, a university hospital. SE declares consultancies from Aerogen Ltd, research support from Aerogen Ltd, Fisher & Paykel healthcare, Hamilton medical, travel reimbursements from Aerogen Ltd and Fisher & Paykel. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Distribution of day-1 Crs (a) and day-1 Crs/IBW (b). Crs: compliance of the respiratory system, IBW: ideal body weight
Fig. 2
Fig. 2
Proportion of patients breathing without assistance at day-28 according to Crs (a, p for trend = 0.11) and Pplat (b, p for trend = 0.03) quintiles
Fig. 3
Fig. 3
Relation between day-1 and day-14 Crs (n  = 108). a shows the regression line (continuous) between day-14 and day-1 Crs compared to the y = x (dotted line). b shows the same data according to three day-28 outcomes: patients extubated (empty circles) patients still on mechanical ventilation (grey circles) and patients who died (black circles) and their respective regression lines
See this image and copyright information in PMC

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