The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients
Authors: Torres Antoni , Motos Anna , Riera Jordi , Fernández-Barat Laia , Ceccato Adrián , Pérez-Arnal Raquel , García-Gasulla Dario , Peñuelas Oscar , Lorente José Angel , Rodriguez Alejandro , de Gonzalo-Calvo David , Almansa Raquel , Gabarrús Albert , Menéndez Rosario , Bermejo-Martin Jesús F. , Ferrer Ricard , Amaya Villar Rosario , Añón José M. , Barberà Carme , Barberán José , Blandino Ortiz Aaron , Bustamante-Munguira Elena , Caballero Jesús , Carbajales Cristina , Carbonell Nieves , Catalán-González Mercedes , Galbán Cristóbal , Gumucio-Sanguino Víctor D. , de la Torre Maria del Carmen , Díaz Emili , Estella Ángel , Gallego Elena , García Garmendia José Luis , Garnacho-Montero José , Gómez José M. , Huerta Arturo , Jorge García Ruth Noemí , Loza-Vázquez Ana , Marin-Corral Judith , Martínez de la Gándara Amalia , Martínez Varela Ignacio , López Messa Juan , M. Albaiceta Guillermo , Novo Mariana Andrea , Peñasco Yhivian , Pozo-Laderas Juan Carlos , Ricart Pilar , Salvador-Adell Inmaculada , Sánchez-Miralles Angel , Sancho Chinesta Susana , Socias Lorenzo , Solé-Violan Jordi , Suares Sipmann Fernando , Tamayo Lomas Luis , Trenado José , Barbé Ferran ,   CIBERESUCICOVID Project (COV20/00110, ISCIII), Adell-Serrano Berta , Agrifoglio Alexander , Aguilar Cabello María , Aguilera Luciano , Alcaraz-Serrano Victoria , Aldecoa Cesar , Alegre Cynthia , Álvarez Sergio , Álvarez Ruiz Antonjo , Andrea Rut , Ángel José , Arrieta Marta , Ayestarán J. Ignacio , Badia Joan Ramon , Badía Mariona , Báez Pravia Orville , Mariño Ana Balan , Balsera Begoña , Barbena Laura , Barbeta Enric , Bardi Tommaso , Barral Segade Patricia , Barroso Marta , Berezo García José Ángel , Bigas Judit , Blancas Rafael , Blasco Cortés María Luisa , Boado María , Bodi Saera María , Bofill Neus , Bouza Vieiro María Teresa , Bueno Leticia , Bustamante-Munguira Juan , Cachafeiro Lucia , Campi Hermoso David , Campos Fernández Sandra , Cano Iosune , Cantón-Bulnes Maria Luisa , Cardina Fernández Pablo , Carrión García Laura , Carvalho Sula , Casacuberta-Barberà Núria , Castellà Manuel , Castellví Andrea , Castro Pedro , Cicuendez Ávila Ramon , Cillóniz Catia , Clar Luisa , Climent Cristina , Codina Jordi , Conde Pamela , Contreras Sofía , Martin María Cruz , de Pablo Sánchez Raul , De Mendoza Diego , del Busto Martínez Cecilia , Díaz Yolanda , Rivas Vilas María Digna , Dólera Moreno Cristina , Dot Irene , Enríquez Giraudo Pedro , Esmorís Arijón Inés , Farre Monjo Teresa , Fernández Javier , Ferrando Carlos , Figueras Albert , Forcadell-Ferreres Eva , Forcelledo Espina Lorena , Franco Nieves , Furro Àngels , García Felipe , García Beatriz , García Prieto Emilio , García Redruello Carlos , García Sagastume Amaia , Gascón Castillo Maria Luisa , Gomà Gemma , Gómez Casal Vanesa , Gómez Silvia , Gómez Gonzalez Carmen , González Jessica , Gordo Federico , Gracia Maria Pilar , Herraiz Alba , Herrán-Monge Rubén , Ibarz Mercedes , Iglesias Silvia , Janer Maria Teresa , Jiménez Gabriel , Juan Díaz Mar , Kiarostami Karsa , Lazo Álvarez Juan I. , León Miguel , López-Gavín Alexandre , López Lago Ana , Macias Guerrero Desire , Mamolar Herrera Nuria , Mañez Mendiluce Rafael , Mantellini Cecilia L. , Marco Naya Gregorio , Marcos Pilar , Marmol Peis Enrique , Martín Vicente Paula , Martínez María , Martínez Fernández Carmen Eulalia , Martínez Juan Maria Dolores , Masa Jimenez Juan Fernando , Masclans Joan Ramon , Maseda Emilio , Menor Fernández Eva María , Miralbés Mar , Monclou Josman , Montejo-González Juan Carlos , Montserrat Neus , Mora Aznar María , Moral-Parras Pedro , Morales Dulce , Moreno Cano Sara Guadalupe , Mosquera Rodríguez David , Muñoz-Bermúdez Rosana , Nicolás José María , Nogue Bou Ramon , Nogueras Salinas Rafaela , Ocón Marta , Ortega Ana , Ossa Sergio , Pagliarani Pablo , Parera Pous Anna , Parrilla Francisco , Pérez Bastida Leire , Pérez Purificación , Pérez Planelles Gloria , Rubio Eva Pérez , Pestaña Laguna David , Piñol-Tena Àngels , Prados Javier , Pujol Andrés , Ramon Coll Núria , Renedo Sanchez-Giron Gloria , Roche-Campo Ferran , Rodriguez Laura , Rodríguez de Castro Felipe , Rodríguez Silvia , Rodríguez Ruiz Covadonga , Rubio Jorge , Rubio López Alberto , Ruiz Miralles Miriam , Ryan Murúa Pablo , Saborido Paz Eva , Salazar Degracia Ana , Sanchez Miguel , Sánchez Ana , Santacoloma Bitor , Sariñena Maria Teresa , Segura Pensado Marta , Serra Lidia , Serra-Fortuny Mireia , Serrano Lázaro Ainhoa , Servià Lluís , Soliva Laura , Speziale Carla , Tognetti Daniel , Tormos Adrián , Torres Mateu , Trefler Sandra , Trujillano Javier , Úbeda Alejandro , Urrelo-Cerrón Luis , Val Estela , Valdivia Ruiz Luis , Vallverdú Montserrat , Van der Hofstadt Martin-Montalvo Maria , Vara Adrio Sabela , Vázquez Nil , Vengoechea Javier , Vidal Cortes Pablo , Vilà-Vilardel Clara , Vilanova Judit , Villada Warrington Tatiana , Yang Hua , Yang Minlan , Zapatero Ana 
Published: September 2021

Background

Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission.

Methods

Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.

Results

Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07],p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09],p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00],p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2variation was observed (OR 0.99 [CI 0.95 to 1.02],p = 0.47).

Conclusions

Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2variation.