Association between lung compliance phenotypes and mortality in COVID-19 patients with acute respiratory distress syndrome

• Published in: Annals of the Academy of Medicine, Singapore Vol. 50; no. 9; pp. 686 - 694
• Main Authors: Puah, Ser Hon, Cove, Matthew Edward, Phua, Jason, Kansal, Amit, Venkatachalam, Jonathen, Ho, Vui Kian, Sewa, Duu Wen, Gokhale, Roshni Sadshiv, Liew, Mei Fong, Ho, Benjamin Choon Heng, Ng, Jensen Jiansheng, Abisheganaden, John A, Leo, Yee Sin, Young, Barnaby Edward, Lye, David Chien, Yeo, Tsin Wen
• Format: Journal Article
• Language: English
• Published: 01.09.2021
• ISSN: 0304-4602; 2972-4066; 0304-4602; 2972-4066
• DOI: 10.47102/annals-acadmedsg.2021129

ABSTRACT Introduction: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS. Methods: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H2O) and low (<40mL/cm H2O) compliance were analysed. Results: A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67–75 versus median 61 years, IQR 52–66; P<0.01), and required a longer duration of ventilation (26 days, IQR 12–27 vs 8 days, IQR 5–15; P<0.01) and intensive care unit support (26 days, IQR 11–30 vs 11.5 days, IQR 7–17.3; P=0.01), with a higher incidence of acute kidney injury (15 patients [100%] vs 40 patients [46%]; P<0.01). There were 67 patients who had lung compliance data; 24 (35.8%) were classified as having high compliance and 43 (64.2%) as having low compliance. Mortality was higher in patients with high compliance (33.3% vs 11.6%; P=0.03), and was associated with a drop in compliance at day 7 (-9.3mL/cm H2O (IQR -4.5 to -15.4) vs 0.2mL/cm H2O (4.7 to -5.2) P=0.04). Conclusion: COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death. Keywords: ARDS, COVID-19-associated respiratory failure, high-flow nasal cannula therapy, HFNC, post-intubation, ventilation strategies