Please use this identifier to cite or link to this item: doi:10.22028/D291-37948
Title: Respiratory Physiology of COVID-19 and Influenza Associated Acute Respiratory Distress Syndrome
Author(s): Kronibus, Niklas
Seiler, Frederik
Danziger, Guy
Muellenbach, Ralf M.
Reyher, Christian
Becker, André P.
Kamphorst, Maren
Rixecker, Torben M.
Metz, Carlos
Bals, Robert
Lepper, Philipp M.
Mang, Sebastian
Language: English
Title: Journal of Clinical Medicine
Volume: 11
Issue: 21
Publisher/Platform: MDPI
Year of Publication: 2022
Free key words: coronavirus-disease 2019 (COVID-19)
acute respiratory distress syndrome (ARDS)
mechanical ventilation
influenza A/B
extracorporeal membrane oxygenation (ECMO)
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: There is ongoing debate whether lung physiology of COVID-19-associated acute respiratory distress syndrome (ARDS) differs from ARDS of other origin. Objective: The aim of this study was to analyze and compare how critically ill patients with COVID-19 and Influenza A or B were ventilated in our tertiary care center with or without extracorporeal membrane oxygenation (ECMO). We ask if acute lung failure due to COVID-19 requires different intensive care management compared to conventional ARDS. Methods: 25 patients with COVID-19-associated ARDS were matched to a cohort of 25 Influenza patients treated in our center from 2011 to 2021. Subgroup analysis addressed whether patients on ECMO received different mechanical ventilation than patients without extracorporeal support. Results: Compared to Influenza-associated ARDS, COVID-19 patients had higher ventilatory system compliance (40.7 mL/mbar [31.8–46.7 mL/mbar] vs. 31.4 mL/mbar [13.7–42.8 mL/mbar], p = 0.198), higher ventilatory ratio (1.57 [1.31–1.84] vs. 0.91 [0.44–1.38], p = 0.006) and higher minute ventilation at the time of intubation (mean minute ventilation 10.7 L/min [7.2–12.2 L/min] for COVID-19 vs. 6.0 L/min [2.5–10.1 L/min] for Influenza, p = 0.013). There were no measurable differences in P/F ratio, positive end-expiratory pressure (PEEP) and driving pressures (∆P). Respiratory system compliance deteriorated considerably in COVID-19 patients on ECMO during 2 weeks of mechanical ventilation (Crs, mean decrease over 2 weeks −23.87 mL/mbar ± 32.94 mL/mbar, p = 0.037) but not in ventilated Influenza patients on ECMO and less so in ventilated COVID-19 patients without ECMO. For COVID-19 patients, low driving pressures on ECMO were strongly correlated to a decline in compliance after 2 weeks (Pearson’s R 0.80, p = 0.058). Overall mortality was insignificantly lower for COVID-19 patients compared to Influenza patients (40% vs. 48%, p = 0.31). Outcome was insignificantly worse for patients requiring veno-venous ECMO in both groups (50% mortality for COVID-19 on ECMO vs. 27% without ECMO, p = 0.30/56% vs. 34% mortality for Influenza A/B with and without ECMO, p = 0.31). Conclusion: The pathophysiology of early COVID-19-associated ARDS differs from Influenza-associated acute lung failure by sustained respiratory mechanics during the early phase of ventilation. We question whether intubated COVID-19 patients on ECMO benefit from extremely low driving pressures, as this appears to accelerate derecruitment and consecutive loss of ventilatory system compliance.
DOI of the first publication: 10.3390/jcm11216237
Link to this record: urn:nbn:de:bsz:291--ds-379482
ISSN: 2077-0383
Date of registration: 11-Nov-2022
Faculty: M - Medizinische Fakultät
Department: M - Innere Medizin
Professorship: M - Prof. Dr. Robert Bals
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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