Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jul 28;25(1):263.
doi: 10.1186/s13054-021-03667-6.

Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS

Annalisa Boscolo #  1 , Nicolò Sella #  2 , Giulia Lorenzoni  3 , Tommaso Pettenuzzo  1 , Laura Pasin  1 , Chiara Pretto  2 , Martina Tocco  2 , Enrico Tamburini  2 , Alessandro De Cassai  1 , Paolo Rosi  4 , Enrico Polati  5 , Katia Donadello  5 , Leonardo Gottin  5 , Silvia De Rosa  6 , Fabio Baratto  7 , Fabio Toffoletto  8 , V Marco Ranieri  9 , Dario Gregori  3 , Paolo Navalesi  10   11 ; COVID-19 VENETO ICU Network
Collaborators, Affiliations
Observational Study

Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS

Annalisa Boscolo et al. Crit Care. .

Abstract

Background: Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS.

Methods: Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients.

Results: A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings.

Conclusions: Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.

Keywords: ARDS; COVID-19; Driving pressure; Mechanical ventilation; Respiratory system compliance.

PubMed Disclaimer

Conflict of interest statement

None related to the present work. PN received royalties from Intersurgical for Helmet Next invention and speaking fees from Philips, Resmed, MSD, Drager and Novartis. The other authors have no other competing interests to declare.

Figures

Fig. 1
Fig. 1
Flow chart of enrolled patients. ICU intensive care unit, HFOT high flow oxygen therapy, NIV non-invasive ventilation, CMV controlled mechanical ventilation, ARDS acute respiratory distress syndrome, DP driving pressure, Crs static compliance of the respiratory system
Fig. 2
Fig. 2
Solid lines indicate the log-odds of ICU mortality, while grey areas 95% confidence interval. A Association between static compliance of the respiratory system and intensive care unit mortality. The p value for nonlinearity was 0.01. The nonlinear effect of static compliance of the respiratory system on the intensive care unit mortality risk was modelled using restricted cubic splines. The odds ratio is presented for the interquartile ranges of the study population. B Association between driving pressure and intensive care unit mortality. Because p value for nonlinearity was 0.68, nonlinearity was not implemented in the model. The odds ratio is presented for clinically relevant range of values, according to published data [5, 6]. C Association between tidal volume and intensive care unit mortality. Because p value for nonlinearity was 0.20, nonlinearity was not implemented in the model. The odds ratio is presented for clinically relevant range of values, according to literature data [2, 4]. ICU intensive care unit, Crs static compliance of the respiratory system, DP driving pressure, Vt tidal volume, IBW ideal body weight, OR odds ratio, 95% CI 95% confidence interval
See this image and copyright information in PMC

References

    1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, ARDS Definition Task Force et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. - PubMed
    1. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–1102. doi: 10.1007/s00134-020-06033-2. - DOI - PMC - PubMed
    1. Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, et al. COVID-19-associated acute respiratory distress syndrome: Is a different approach to management warranted? Lancet Respir Med. 2020;8(8):816–821. doi: 10.1016/S2213-2600(20)30304-0. - DOI - PMC - PubMed
    1. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308. doi: 10.1056/NEJM200005043421801. - DOI - PubMed
    1. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747–755. doi: 10.1056/NEJMsa1410639. - DOI - PubMed

Publication types