Differences of respiratory mechanics in mechanical ventilation of acute respiratory distress syndrome between patients with COVID-19 and Influenza A

• Published in: Respiratory research Vol. 25; no. 1; p. 112
• Main Authors: Chung, Eunki, Leem, Ah Young, Chung, Kyung Soo, Kang, Young Ae, Park, Moo Suk, Kim, Young Sam, Jang, Hye Jin, Lee, Su Hwan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.03.2024; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Analysis; Artificial respiration; Blood pressure; Care and treatment; Comparative analysis; Complications and side effects; COVID-19; Diagnosis; Disease prevention; Edema; Health aspects; Histology, Pathological; Hospitalization; Influenza; Influenza A; Intubation; Mechanical properties; Mechanical ventilation; Mechanics; Mechanics (physics); Medical research; Medicine, Experimental; Mortality; Ostomy; Oxygen; Partial pressure; Patient outcomes; Patients; Respiration; Respiratory distress syndrome; Risk factors; Success; Tracheotomy; Variables; Ventilation; Ventilators; Weaning; United Kingdom; South Korea; Acute respiratory distress syndrome; COVID-19; Influenza A; Mechanical ventilation
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-024-02730-4

Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS. This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation. The median age of the 87 participants was 71.0 (62.0-78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p < 0.001, day 1). COVID-19 and influenza A initially showed different directions for peak inspiratory pressure and dynamic compliance; however, after day 3, both groups exhibited similar directions. Dynamic driving pressure exhibited opposite trends between the two groups during mechanical ventilation. Respiratory mechanics show clear differences between COVID-19-induced ARDS and influenza A induced ARDS. Based on these findings, we can consider future treatment strategies for COVID-19-induced ARDS.