An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients
Authors: Li Bassi Gianluigi , Suen Jacky Y. , Dalton Heidi J. , White Nicole , Shrapnel Sally , Fanning Jonathon P. , Liquet Benoit , Hinton Samuel , Vuorinen Aapeli , Booth Gareth , Millar Jonathan E. , Forsyth Simon , Panigada Mauro , Laffey John , Brodie Daniel , Fan Eddy , Torres Antoni , Chiumello Davide , Corley Amanda , Elhazmi Alyaa , Hodgson Carol , Ichiba Shingo , Luna Carlos , Murthy Srinivas , Nichol Alistair , Ng Pauline Yeung , Ogino Mark , Pesenti Antonio , Trieu Huynh Trung , Fraser John F. ,   the COVID-19 Critical Care Consortium, Al-Dabbous Tala , Alfoudri Huda , Shamsah Mohammed , Elapavaluru Subbarao , Berg Ashley , Horn Christina , Schroll Stephan , Velazco Jorge , Fikes Wanda , Ploskanych Ludmyla , Meyer Dan , Shalabi-McGuire Maysoon , Witt Trent , Ehlers Ashley , Grazioli Lorenzo , Grandin E. Wilson , Nunez Jose , Reyes Tiago , Joseph Mark , Mitchell Brook , Tenzer Martha , Abe Ryuzo , Hayashi Yosuke , Cho Hwa Jin , Jeong In Seok , Brozzi Nicolas , Hernandez-Montfort Jaime , Mehkri Omar , Houltham Stuart , Graf Jerónimo , Perez Rodrigo , Diaz Roderigo , Delgado Camila , González Joyce , Sanchez Maria Soledad , Rincón Diego Fernando Bautista , Duque Melissa Bustamante , Yanten Angela Maria Marulanda , Brodie Dan , Rusmawatiningtyas Desy , Ragazzo Gabrielle , Taufik Azhari , Gunawan Margaretha , Irawany Vera , Rayhan Muhammad , Wardoyo Elizabeth Yasmin , Panigada Mauro , Coppola Silvia , Colombo Sebastiano , Grasselli Giacomo , Leone Michela , Zanella Alberto , Antonelli Massimo , Carelli Simone , Grieco Domenico L. , Asaki Motohiro , Hoshino Kota , Salazar Leonardo , Duarte Laura , McCaffrey Joseph , Bone Allison , Thomson David , Arnold-Day Christel , Cupido Jerome , Fanie Zainap , Miller Malcom , Seymore Lisa , van Straaten Dawid , Hassan Ibrahim , Hssain Ali Ait , Aliudin Jeffrey , Alqahtani Al-Reem , Mohamed Khoulod , Mohamed Ahmed , Tan Darwin , Villanueva Joy , Zaqout Ahmed , Kurtzman Ethan , Ademi Arben , Dobrita Ana , Aoudi Khadija El , Segura Juliet , Giwangkancana Gezy , Ohshimo Shinichiro , Hoshino Koji , Hitoshi Saito , Uchinami Yuka , Osatnik Javier , Joosten Anne , Torres Antoni , Motos Ana , Yang Minlan , Luna Carlos , Arancibia Francisco , Williams Virginie , Noel Alexandre , Luque Nestor , Trung Trieu Huynh , Yacoub Sophie , Fantini Marina , García Ruth Noemi Jorge , Alvarez Enrique Chicote , Greti Anna , Lomeli Oscar , Ceccato Adrian , Sanchez Angel , Vazquez Ana Loza , Roche-Campo Ferran , Tuazon Divina , Duculan Toni , Shimizu Hiroaki , Amato Marcelo , Cassimiro Luciana , Pola Flavio , Ribeiro Francis , Fonseca Guilherme , Dalton Heidi , Desai Mehul , Osborn Erik , Deeb Hala , Arcadipane Antonio , Bianco Claudia , Cuffaro Raffaele , Martucci Gennaro , Occhipinti Giovanna , Rossetti Matteo , Vitiello Chiara , Cho Sung-Min , Calligy Kate , Whitman Glenn , Shimizu Hiroaki , Moriyama Naoki , Kim Jae-Burm , Kitamura Nobuya , Shimazui Takashi , Al-Hudaib Abdullah , Elhazmi Alyaa , Gebauer Johannes , Yokoyama Toshiki , Al-Fares Abdulrahman , Alamad Esam , Alawadhi Fatma , Alawadi Kalthoum , Buabbas Sarah , Tanaka Hiro , Hashimoto Satoru , Yamazaki Masaki , Oh Tak-Hyuck , Epler Mark , Forney Cathleen , Feister Jared , Grobengieser Katherine , Kruse Louise , Williamson Joelle , Gnall Eric , Caroline Mara , Golden Sasha , Karaj Colleen , McDermott Sherry , Sher Lynn , Shapiro Timothy , Thome Lisa , Vanderland Mark , Welch Mary , Brazzi Luca , Ogston Tawnya , Nagpal Dave , Fischer Karlee , Lorusso Roberto , de Piero Maria , Esperatti Mariano , O’Briain Diarmuid , Carton Edmund G. , Sen Ayan , Palacios Amanda , Rainey Deborah , Seefeldt Cassandra , Durham Lucia , Falcucci Octavio , Emmrich Amanda , Guy Jennifer , Johns Carling , Neumann Emily , Buchtele Nina , Schwameis Michael , Stecher Stephanie-Susanne , Singh Delila , Barnikel Michaela , Arenz Lukas , Zaaqoq Akram , Galloway Lan Anh , Merley Caitlin , Csete Marc , Quesada Luisa , Saba Isabela , Kasugai Daisuke , Hiraiwa Hiroaki , Tanaka Taku , Marwali Eva , Purnama Yoel , Dewayanti Santi Rahayu , Ardiyan  , Siagian Debby , Chen Yih-Sharng , Laffey John , McNicholas Bairbre , Cosgrave David , VanDyk Marlice , MacDonald Sarah , Seppelt Ian , Ratsep Indrek , Enneveer Lauri , Erikson Kristo , Oigus Getter , Post Andra-Maris , Sillaots Piret , Manetta Frank , Komats Mamoru , Satyapriya S. Veena , Bhatt Amar , Echeverria Marco , Fiorda Juan , Gonzalez Alicia , Mokadam Nahush A. , McKeown Johnny , Pasek Joshua , Shi Haixia , Uribe Alberto , Moreno Rita , Zakhary Bishoy , Johnson Hannah , Pow Nolan , Cavana Marco , Cucino Alberto , Foti Giuseppe , Giani Marco , Russotto Vincenzo , Chiumello Davide , Castagna Valentina , Dell’Amore Andrea , Shum Hoi-Ping , Vuysteke Alain , Usman Asad , Acker Andrew , Mergler Blake , Rizer Nicolas , Sertic Federico , Smood Benjamin , Sperry Alexandra , Subramanian Madhu , Lolong Navy , Akmal Ernita , Burhan Erlina , Rasmin Menaldi , Naivedh Bhat , Sitompu Faya , Barrett Peter , Daugherty Julia , Dean David , Loforte Antonio , Khan Irfan , DeSantis Olivia , Quraishi Mohammed Abraar , Salt Gavin , So Dominic , Kandamby Darshana , Mandei Jose M. , Natanael Hans , YudhaLantang Eka , Lantang Anastasia , Jung Anna , Hammond Terese , Ng George , Ng Wing Yiu , Yeung Pauline , Adachi Shingo , Blanco Pablo , Prieto Ana , Sánchez Jesús , Nicholson Meghan , Farquharson Michael , Butt Warwick , Serratore Alyssa , Delzoppo Carmel , Janin Pierre , Yarad Elizabeth , Totaro Richard , Coles Jennifer , Balk Robert , Fox Samuel , Hays James , Kapania Esha , Mishin Pavel , Vissing Andy , Yantosh Garrett , Yuliarto Saptadi , Santoso Kohar Hari , Djajalaksana Susanthy , Fatoni Arie Zainul , Fukuda Masahiro , Liu Keibun , Pelosi Paolo , Battaglini Denise , Jiménez Juan Fernando Masa , Gaião Sérgio , Roncon-Albuquerque Roberto , Buchner Jessica , Cho Young-Jae , Lee Sang Min , Lee Su Hwan , Kawasaki Tatsuya , Sakiyalak Pranya , Nitayavardhana Prompak , Seitz Tamara , Arora Rakesh , Kent David , Parwar Swapnil , Cheng Andrew , Miller Jennene , Marino Daniel , Deacon Jillian E. , Fujitani Shigeki , Shimizu Naoki , Madhok Jai , Owyang Clark , Buscher Hergen , Reynolds Claire , Maasikas Olavi , Beljantsev Aleksandr , Mihnovits Vladislav , Akimoto Takako , Aizawa Mariko , Horibe Kanako , Onodera Ryota , Hodgson Carol , Young Meredith , Smith Timothy , Bartone Cheryl , George Timothy , Shekar Kiran , McGuinness Niki , Irvine Lacey , Flynn Brigid , Houchin Abigail , Shimizu Keiki , Hamaguchi Jun , Lussier Leslie , Kersker Grace , Reich John Adam , Lotz Gösta , Malfertheiner Maximilian , Dreier Esther , Maier Lars , Kusumastuti Neurinda Permata , McCloskey Colin , Dabaliz Al-Awwab , Elshazly Tarek B. , Smith Josiah , Szuldrzynski Konstanty S. , Bielański Piotr , Hakeem Yusuff , Wille Keith , Holt Rebecca , Parhar Ken Kuljit S. , Fiest Kirsten M. , Codan Cassidy , Shahid Anmol , Fayed Mohamed , Evans Timothy , Garcia Rebekah , Gutierrez Ashley , Shimizu Hiroaki , Song Tae , Rose Rebecca , Bennett Suzanne , Richardson Denise , Peek Giles , Lopez-Colon Dalia , Arora Lovkesh , Rappapport Kristina , Rudolph Kristina , Sibenaller Zita , Stout Lori , Walter Alicia , Herr Daniel , Vedadi Nazli , Sindt Lace , Ewald Cale , Hoffman Julie , Rajnic Sean , Thompson Shaun , Kennedy Ryan , Griffee Matthew , Ciullo Anna , Kida Yuri , Roca Ricard Ferrer , Alegre Cynthia , Contreras Sofia , Riera JordI , Kay Christy , Fischer Irene , Renner Elizabeth , Taniguci Hayato , Abbate Gabriella , Hassan Halah , Heinsar Silver , Karnik Varun A. , Ki Katrina , O’Neill Hollier F. , Obonyo Nchafatso , Pimenta Leticia Pretti , Reid Janice D. , Sato Kei , Shekar Kiran , Vuorinen Aapeli , Wildi Karin S. , Wood Emily S. , Yerkovich Stephanie 
Published: June 2021

Background

Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.

Methods

We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS—calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.

Results

We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: − 11.8 to − 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease − 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI − 0.48 to − 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p = 0.018).

Conclusions

This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study.

Trial registration: ACTRN12620000421932.