A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study
Abstract Background The Acute Respiratory Distress Syndrome (ARDS) is characterized by lung inflammation and edema, impairing both oxygenation and lung compliance. Recent studies reported a dissociation between oxygenation and compliance (severe hypoxemia with preserved compliance) in early ARDS and...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-023-02626-9 |
| _version_ | 1797362895892250624 |
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| author | Eleni Papoutsi Ioannis Andrianopoulos Vasiliki Mavrikaki Maria Bolaki Vagia Stamatopoulou Eleni Toli Georgios Papathanakos Vasilios Koulouras Eumorfia Kondili Ilias I. Siempos Katerina Vaporidi |
| author_facet | Eleni Papoutsi Ioannis Andrianopoulos Vasiliki Mavrikaki Maria Bolaki Vagia Stamatopoulou Eleni Toli Georgios Papathanakos Vasilios Koulouras Eumorfia Kondili Ilias I. Siempos Katerina Vaporidi |
| author_sort | Eleni Papoutsi |
| collection | DOAJ |
| description | Abstract Background The Acute Respiratory Distress Syndrome (ARDS) is characterized by lung inflammation and edema, impairing both oxygenation and lung compliance. Recent studies reported a dissociation between oxygenation and compliance (severe hypoxemia with preserved compliance) in early ARDS and COVID-19-related-ARDS (CARDS). During the pandemic, in patients requiring prolonged mechanical ventilation, we observed the opposite combination (mild-moderate hypoxemia but significantly impaired compliance). The purpose of our study was to investigate the prevalence of this combination of mild-moderate hypoxemia and impaired compliance in persistent ARDS and CARDS. Methods For this retrospective study, we used individual patient-level data from two independent cohorts of ARDS patients. The ARDSNet cohort included patients from four ARDS Network randomized controlled trials. The CARDS cohort included patients with ARDS due to COVID-19 hospitalized in two intensive care units in Greece. We used a threshold of 150 for PaO2/FiO2 and 30 ml/cmH2O for compliance, estimated the prevalence of each of the four combinations of oxygenation and compliance at baseline, and examined the change in its prevalence from baseline to day 21 in the ARDSNet and CARDS cohorts. Results The ARDSNet cohort included 2909 patients and the CARDS cohort included 349 patients. The prevalence of the combination of mild-moderate hypoxemia and low compliance increased from baseline to day 21 both in the ARDSNet cohort (from 22.2 to 42.7%) and in the CARDS cohort (from 3.1 to 33.3%). Among surviving patients with low compliance, oxygenation improved over time. The 60-day mortality rate was higher for patients who had mild-moderate hypoxemia and low compliance on day 21 (28% and 56% in ARDSNet and CARDS), compared to those who had mild-moderate hypoxemia and high compliance (20% and 50%, respectively). Conclusions Among patients with ARDS who require prolonged controlled mechanical ventilation, regardless of ARDS etiology, a dissociation between oxygenation and compliance characterized by mild-moderate hypoxemia but low compliance becomes increasingly prevalent. The findings of this study highlight the importance of monitoring mechanics in patients with persistent ARDS. |
| first_indexed | 2024-03-08T16:14:00Z |
| format | Article |
| id | doaj.art-1a8698aa5ffe47a8b4909cd8fbbe2b01 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-03-08T16:14:00Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-1a8698aa5ffe47a8b4909cd8fbbe2b012024-01-07T12:41:13ZengBMCRespiratory Research1465-993X2024-01-012511910.1186/s12931-023-02626-9A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective studyEleni Papoutsi0Ioannis Andrianopoulos1Vasiliki Mavrikaki2Maria Bolaki3Vagia Stamatopoulou4Eleni Toli5Georgios Papathanakos6Vasilios Koulouras7Eumorfia Kondili8Ilias I. Siempos9Katerina Vaporidi10First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical SchoolDepartment of Intensive Care Unit, University Hospital of IoanninaDepartment of Intensive Care, University Hospital of Heraklion, University of Crete School of MedicineDepartment of Intensive Care, University Hospital of Heraklion, University of Crete School of MedicineDepartment of Intensive Care, University Hospital of Heraklion, University of Crete School of MedicineDepartment of Intensive Care Unit, University Hospital of IoanninaDepartment of Intensive Care Unit, University Hospital of IoanninaDepartment of Intensive Care Unit, University Hospital of IoanninaDepartment of Intensive Care, University Hospital of Heraklion, University of Crete School of MedicineFirst Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical SchoolDepartment of Intensive Care, University Hospital of Heraklion, University of Crete School of MedicineAbstract Background The Acute Respiratory Distress Syndrome (ARDS) is characterized by lung inflammation and edema, impairing both oxygenation and lung compliance. Recent studies reported a dissociation between oxygenation and compliance (severe hypoxemia with preserved compliance) in early ARDS and COVID-19-related-ARDS (CARDS). During the pandemic, in patients requiring prolonged mechanical ventilation, we observed the opposite combination (mild-moderate hypoxemia but significantly impaired compliance). The purpose of our study was to investigate the prevalence of this combination of mild-moderate hypoxemia and impaired compliance in persistent ARDS and CARDS. Methods For this retrospective study, we used individual patient-level data from two independent cohorts of ARDS patients. The ARDSNet cohort included patients from four ARDS Network randomized controlled trials. The CARDS cohort included patients with ARDS due to COVID-19 hospitalized in two intensive care units in Greece. We used a threshold of 150 for PaO2/FiO2 and 30 ml/cmH2O for compliance, estimated the prevalence of each of the four combinations of oxygenation and compliance at baseline, and examined the change in its prevalence from baseline to day 21 in the ARDSNet and CARDS cohorts. Results The ARDSNet cohort included 2909 patients and the CARDS cohort included 349 patients. The prevalence of the combination of mild-moderate hypoxemia and low compliance increased from baseline to day 21 both in the ARDSNet cohort (from 22.2 to 42.7%) and in the CARDS cohort (from 3.1 to 33.3%). Among surviving patients with low compliance, oxygenation improved over time. The 60-day mortality rate was higher for patients who had mild-moderate hypoxemia and low compliance on day 21 (28% and 56% in ARDSNet and CARDS), compared to those who had mild-moderate hypoxemia and high compliance (20% and 50%, respectively). Conclusions Among patients with ARDS who require prolonged controlled mechanical ventilation, regardless of ARDS etiology, a dissociation between oxygenation and compliance characterized by mild-moderate hypoxemia but low compliance becomes increasingly prevalent. The findings of this study highlight the importance of monitoring mechanics in patients with persistent ARDS.https://doi.org/10.1186/s12931-023-02626-9Acute respiratory failureAcute respiratory distress syndromeCOVID-19Prolonged mechanical ventilation |
| spellingShingle | Eleni Papoutsi Ioannis Andrianopoulos Vasiliki Mavrikaki Maria Bolaki Vagia Stamatopoulou Eleni Toli Georgios Papathanakos Vasilios Koulouras Eumorfia Kondili Ilias I. Siempos Katerina Vaporidi A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study Respiratory Research Acute respiratory failure Acute respiratory distress syndrome COVID-19 Prolonged mechanical ventilation |
| title | A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study |
| title_full | A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study |
| title_fullStr | A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study |
| title_full_unstemmed | A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study |
| title_short | A combination of mild-moderate hypoxemia and low compliance is highly prevalent in persistent ARDS: a retrospective study |
| title_sort | combination of mild moderate hypoxemia and low compliance is highly prevalent in persistent ards a retrospective study |
| topic | Acute respiratory failure Acute respiratory distress syndrome COVID-19 Prolonged mechanical ventilation |
| url | https://doi.org/10.1186/s12931-023-02626-9 |
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