165: Conventional Protective LTV Versus APRV for Patients With Severe COVID-19 Disease

Abstract

INTRODUCTION: It has been postulated that the Acute Respiratory Distress Syndrome (ARDS) secondary to COVID-19 differs from ARDS in its presentation and progression Although a protective low tidal volume ventilation (LTV) is the standard of care for patients with ARDS, the use of Airway Pressure Release Ventilation (APRV) has also been linked to improved outcomes This project aims to compare the clinical outcomes between APRV and LTV in moderate to severe ARDS due to COVID-19 METHODS: Retrospective, single-center cohort study After IRB approval, we reviewed the intensive care unit admissions between March 11 and May 6, 2020 and included adult patients with a confirmed COVID-19 disease and moderate to severe ARDS, as defined by Berlin Criteria We collected baseline demographics and clinical characteristics Our primary outcome was the number of ventilator-free days between APRV and LTV Secondary outcomes included inhospital mortality, number of sedatives, RASS score, use of vasopressors, ICU length of stay, and pneumothorax RESULTS: Out of 423 patients screened, a total of 178 were included in the analysis The 18 patients who received APRV where compared with 160 in the LTV group Baseline demographics, APACHE II on admission, and clinical characteristics were similar between groups All patients received at least one course of steroids during the hospital stay APRV patients received tocilizumab more frequently than LTV patients (33 3% vs 10%, p=0 015) There was no difference in the ventilator free days (LTV 6 1 vs APRV 6 81 days, p=0 49), in-hospital mortality (50% vs 60%, p=0 584), AKI (66 7% vs 71 2%, p=0 8), ventilator-associated pneumonia (33 3% vs 36 2%, p=0 9), ICU length of stay (18 59 vs 21 58, p=0 185) or incidence of pneumothorax (11 1% vs 5% P=0 26) There was a trend for an increased need of vasopressors in the LTV group (80 6% vs 61 1%, P=0 07) Finally, the RASS score was higher in the APRV group (-3 06 vs -2 12, p=0 032) CONCLUSIONS: APRV was not associated with a reduced number of ventilator-free days or in-hospital mortality Other respiratory outcomes were similar between groups Interestingly, patients on APRV tended to require less vasopressors, and were significantly less sedated Prospective studies examining APRV vs LTV for COVID-19 disease are therefore warranted