The following is a summary of “Epidemiology, ventilation management and outcomes of COVID–19 ARDS patients versus patients with ARDS due to pneumonia in the Pre–COVID era,” published in the August 2024 issue of Pulmonology by Ven et al.

This study explores the potential differences in ventilation management between patients with COVID-19-associated ARDS (COVID-ARDS) and those with ARDS before the COVID-19 pandemic (CLASSIC-ARDS), as well as the association of these ventilation practices with patient outcomes. Given the distinct nature of COVID-ARDS, it is still being determined whether the same ventilation strategies and their effects on outcomes observed in CLASSIC-ARDS apply equally to COVID-ARDS.

This individual patient data analysis encompassed six observational studies, including four conducted during the COVID-19 pandemic and two pre-pandemic. A total of 8,117 patients were analyzed, with 6,702 in the COVID-ARDS group and 1,415 in the CLASSIC-ARDS group. Key ventilation parameters, including tidal volume (VT), positive end-expiratory pressure (PEEP), driving pressure (ΔP), and respiratory system compliance (Crs), were compared between the two groups. The primary endpoints were these ventilation parameters, while secondary outcomes included 60-day mortality and ventilator-free days and alive at day 60 (VFD-60).

The analysis revealed significant differences in ventilation management between patients with COVID-ARDS and CLASSIC-ARDS. Patients with COVID-ARDS were ventilated with lower median VT (6.6 vs. 7.3 ml/kg predicted body weight, p < 0.001), higher median PEEP (12.0 vs. 8.0 cm H₂O, p < 0.001), lower median ΔP (13.0 vs. 16.0 cm H₂O, p < 0.001), and higher median Crs (33.5 vs. 28.1 mL/cm H₂O, p < 0.001). Multivariable adjustment indicated that a higher ΔP was independently associated with increased 60-day mortality and fewer VFD-60 in both patient groups. Additionally, higher PEEP was associated with fewer VFD-60, but this relationship was only significant in patients with COVID-ARDS.

The study highlights crucial differences in ventilation strategies between patients with COVID-ARDS and CLASSIC-ARDS and underscores the varying associations of these strategies with clinical outcomes. The findings suggest that while some ventilation practices are broadly applicable across both ARDS types, others, such as the use of higher PEEP, may have differential impacts depending on the underlying etiology of the ARDS, particularly in the context of COVID-19.

Source: respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02910-2