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. 2024 Mar 7;25(1):112.
doi: 10.1186/s12931-024-02730-4.

Differences of respiratory mechanics in mechanical ventilation of acute respiratory distress syndrome between patients with COVID-19 and Influenza A

Eunki Chung  1   2 , Ah Young Leem  2 , Kyung Soo Chung  2 , Young Ae Kang  2 , Moo Suk Park  2 , Young Sam Kim  2 , Hye Jin Jang  3 , Su Hwan Lee  4
Affiliations

Differences of respiratory mechanics in mechanical ventilation of acute respiratory distress syndrome between patients with COVID-19 and Influenza A

Eunki Chung et al. Respir Res. .

Abstract

Background: Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS.

Methods: This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation.

Results: The median age of the 87 participants was 71.0 (62.0-78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p < 0.001, day 1). COVID-19 and influenza A initially showed different directions for peak inspiratory pressure and dynamic compliance; however, after day 3, both groups exhibited similar directions. Dynamic driving pressure exhibited opposite trends between the two groups during mechanical ventilation.

Conclusions: Respiratory mechanics show clear differences between COVID-19-induced ARDS and influenza A induced ARDS. Based on these findings, we can consider future treatment strategies for COVID-19-induced ARDS.

Keywords: Acute respiratory distress syndrome; COVID-19; Influenza A; Mechanical ventilation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Changes in respiratory mechanics between COVID-19-induced ARDS and influenza A induced ARDS. Median values of each parameter, including PIP (A), P/F ratio (B), Cdyn (C), and DP (D), are displayed according to the number of days after intubation. PIP, peak inspiratory pressure; P/F ratio, arterial partial pressure of oxygen (PaO2) divided by inspired oxygen concentration (FiO2); Cdyn, dynamic compliance; DP, dynamic driving pressure
Fig. 2
Fig. 2
Changes in respiratory mechanics between COVID-19-induced ARDS and influenza A induced ARDS survivors. Median values of each parameter, including PIP (A), P/F ratio (B), Cdyn (C), and DP (D), are displayed according to the number of days after intubation. PIP, peak inspiratory pressure; P/F ratio, arterial partial pressure of oxygen (PaO2) divided by inspired oxygen concentration (FiO2); Cdyn, dynamic compliance; DP, dynamic driving pressure
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