Time-Varying INTensity in COVID–19

M. Schuijt; D. van Meenen, I. Martin–Loeches, G. Mazzinari, M.J. Schultz; F. Paulus; A. Serpa Neto.

Background

High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID–19). We investigated the association of exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients.

Methods

Of 1122 patients included in the PRoVENT–COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in ΔP (HR 1.04, 95% CrI 1.01–1.07) and in MP (HR 1.12, 95% CrI 1.01–1.36). In sensitivity analyses, cumulative exposure to higher levels of ΔP or MP resulted in increased risks for 28–day mortality.

Results

In 825 patients included in this analysis, 28–day mortality was 27.5%. ΔP was not independently associated with mortality (HR, 1.02 [95% confidence interval, 0.88–1.18]; P=0.750). MP, however, was independently associated with 28–day mortality (HR, 1.17 [95% CI, 1.01–1.36]; P=0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28–day mortality (HR, 1.15 [95% CI, 1.01 to 1.30]; P=0.028).

Conclusions

Cumulative exposure to higher intensities of ventilation in COVID–19 patients with ARDS have an association with increased risk of 28–day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients.