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
. 2023 Apr 11;9(2):00554-2022.
doi: 10.1183/23120541.00554-2022. eCollection 2023 Mar.

Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

Adel Maamar  1   2 , Pauline Guillot  1   2 , Vincent Joussellin  1   2 , Flora Delamaire  1   2 , Benoit Painvin  1   2 , Anaëlle Bichon  1   2 , Océane Bernard de la Jartre  1   2 , Matteo Mauget  1   2 , Mathieu Lesouhaitier  1   2   3 , Jean Marc Tadié  1   2   3 , Nicolas Terzi  1   2   3 , Arnaud Gacouin  1   2   3
Affiliations

Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

Adel Maamar et al. ERJ Open Res. .

Abstract

Background: This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P aO2 )/inspiratory oxygen fraction (F IO2 ) ≤150 mmHg.

Methods: We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C rs), ventilator ratio, corrected minute ventilation (V'Ecorr) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.

Results: On day 1 of ARDS, COVID-19 patients had significantly higher P aO2 /F IO2 (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH2O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V'Ecorr (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min-1; p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P aO2 /F IO2 , arterial carbon dioxide tension, ventilatory ratio and V'Ecorr differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43).

Conclusions: Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
a) Arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FIO2), b) arterial carbon dioxygen tension (PaCO2), c) ventilatory ratio and d) corrected minute ventilation (V′Ecorr) in matched patients with COVID-19 and influenza from day 1 to day 5 of moderate-to-severe acute respiratory distress syndrome. Box-and-whisker plots display median, 10th, 25th, 75th and 90th percentiles, as well as outliers. *: p<0.05; **: p<0.01; ***: p<0.001; ****: p<0.0001; ns: nonsignificant.
FIGURE 2
FIGURE 2
Principal component analysis of COVID-19 and influenza acute respiratory distress syndrome with arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FIO2) ≤150 mmHg. Two dimensions (Dim1 and Dim2) are represented on the x- and y-axis, respectively. Ventilatory variables entered into the analysis correspond to those listed in table 2.
See this image and copyright information in PMC

References

    1. Ackermann M, Verleden SE, Kuehnel M, et al. . Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 2020; 383: 120–128. doi:10.1056/NEJMoa2015432 - DOI - PMC - PubMed
    1. Carsana L, Sonzogni A, Nasr A, et al. . Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis 2020; 20: 1135–1140. doi:10.1016/S1473-3099(20)30434-5 - DOI - PMC - PubMed
    1. Short KR, Kroeze EJBV, Fouchier RAM, et al. . Pathogenesis of influenza-induced acute respiratory distress syndrome. Lancet Infect Dis 2014; 14: 57–69. doi:10.1016/S1473-3099(13)70286-X - DOI - PubMed
    1. Herold S, Becker C, Ridge KM, et al. . Influenza virus-induced lung injury: pathogenesis and implications for treatment. Eur Respir J 2015; 45: 1463–1478. doi:10.1183/09031936.00186214 - DOI - PubMed
    1. Milross L, Majo J, Cooper N, et al. . Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19. Lancet Respir Med 2022; 10: 95–106. doi:10.1016/S2213-2600(21)00408-2 - DOI - PMC - PubMed

LinkOut - more resources