Abstract
Background: Lung mechanics during invasive mechanical ventilation (IMV) for both prognostic and therapeutic implications; however, the full trajectory lung mechanics has never been described for novel coronavirus disease 2019 (COVID-19) patients requiring IMV. The study aimed to describe the full trajectory of lung mechanics of mechanically ventilated COVID-19 patients. The clinical and ventilator setting that can influence patient-ventilator asynchrony (PVA) and compliance were explored. Post-extubation spirometry test was performed to assess the pulmonary function after COVID-19 induced ARDS.Methods: This was a retrospective study conducted in a tertiary care hospital. All patients with IMV due to COVID-19 induced ARDS were included. High-granularity ventilator waveforms were analyzed with deep learning algorithm to obtain PVAs. Asynchrony index (AI) was calculated as the number of asynchronous events divided by the number of ventilator cycles and wasted efforts. Mortality was recorded as the vital status on hospital discharge.Results: A total of 3,923,450 respiratory cycles in 2,778 h were analyzed (average: 24 cycles/min) for seven patients. Higher plateau pressure (Coefficient: −0.90; 95% CI: −1.02 to −0.78) and neuromuscular blockades (Coefficient: −6.54; 95% CI: −9.92 to −3.16) were associated with lower AI. Survivors showed increasing compliance over time, whereas non-survivors showed persistently low compliance. Recruitment maneuver was not able to improve lung compliance. Patients were on supine position in 1,422 h (51%), followed by prone positioning (499 h, 18%), left positioning (453 h, 16%), and right positioning (404 h, 15%). As compared with supine positioning, prone positioning was associated with 2.31 ml/cmH2O (95% CI: 1.75 to 2.86; p < 0.001) increase in lung compliance. Spirometry tests showed that pulmonary functions were reduced to one third of the predicted values after extubation.Conclusions: The study for the first time described full trajectory of lung mechanics of patients with COVID-19. The result showed that prone positioning was associated with improved compliance; higher plateau pressure and use of neuromuscular blockades were associated with lower risk of AI.
Highlights
The novel coronavirus disease 2019 (COVID-19) imposes an important and urgent threat to global health [1, 2]
There is evidence in general acute respiratory distress syndrome (ARDS) population that poor lung compliance without improvement during invasive mechanical ventilation (IMV) is associated with poor clinical outcome [5]
In order to make this gap end, the purpose of the study were 4-folds: [1] to describe the lung mechanics of COVID-19 patients by analyzing high-granularity ventilator waveform data; [2] to explore whether the lung compliance can be influenced by clinical factors, such as recruitment maneuver (RM) and body positioning; [3] to identify risk factors for Patient ventilator asynchrony (PVA) during IMV in COVID-19 patients; and [4] To describe post-extubation lung functions for survivors with spirometry test
Summary
The novel coronavirus disease 2019 (COVID-19) imposes an important and urgent threat to global health [1, 2]. Mechanical ventilation is an important strategy to treat such patients; and lung mechanics can have both prognostic and therapeutic implications. Lung compliance is an important mechanical parameter that should be monitored during IMV. There is evidence in general ARDS population that poor lung compliance without improvement during IMV is associated with poor clinical outcome [5]. Patient ventilator asynchrony (PVA) is another important parameter that should be stressed during IMV. Most studies explored risk factors for PVA in a fixed-time model [14]. Lung mechanics during invasive mechanical ventilation (IMV) for both prognostic and therapeutic implications; the full trajectory lung mechanics has never been described for novel coronavirus disease 2019 (COVID-19) patients requiring IMV. The study aimed to describe the full trajectory of lung mechanics of mechanically ventilated COVID-19 patients. Post-extubation spirometry test was performed to assess the pulmonary function after COVID-19 induced ARDS
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