TY - JOUR
T1 - Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic
AU - Panwar, Rakshit
AU - Madotto, Fabiana
AU - Laffey, John G.
AU - van Haren, Frank M. P.
N1 - Funding Information:
Supported by the European Society of Intensive Care Medicine (ESICM), Brussels, Belgium; by St. Michael’s Hospital, Toronto, Canada; and by the University of Milan-Bicocca, Monza, Italy. ESICM, St. Michael’s Hospital, and University of Milan-Bicocca had no role in the design and conduct of the study; management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Publisher Copyright:
Copyright © 2020 by the American Thoracic Society
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Rationale: A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was characterized as a distinct ARDS phenotype. Objectives: To determine whether such Crs-based phenotypes existed among patients with ARDS before the COVID-19 pandemic and to closely examine the Crs-mortality relationship. Methods: We undertook a secondary analysis of patients with ARDS, who were invasively ventilated on controlled modes and enrolled in a large, multinational, epidemiological study. We assessed Crs, degree of hypoxemia, and associated Crs-based phenotypic patterns with their characteristics and outcomes. Measurements and Main Results: Among 1,117 patients with ARDS who met inclusion criteria, the median Crs was 30 (interquartile range, 23-40) ml/cm H
2O. One hundred thirty-six (12%) patients had preserved Crs (>50 ml/cm H
2O; phenotype with low elastance [“phenotype L”]), and 827 (74%) patients had poor Crs (,40 ml/cm H
2O; phenotype with high elastance [“phenotype H”]). Compared with those with phenotype L, patients with phenotype H were sicker and had more comorbidities and higher hospital mortality (32% vs. 45%; P, 0.05). A near complete dissociation between Pa
O2/FI
O2 and Crs was observed. Of 136 patients with phenotype L, 58 (43%) had a Pa
O2/FI
O2 , 150. In a multivariable-adjusted analysis, the Crs was independently associated with hospital mortality (adjusted odds ratio per ml/cm H
2O increase, 0.988; 95% confidence interval, 0.979-0.996; P = 0.005). Conclusions: A wide range of Crs was observed in non-COVID-19 ARDS. Approximately one in eight patients had preserved Crs. Pa
O2/FI
O2 and Crs were dissociated. Lower Crs was independently associated with higher mortality. The Crs-mortality relationship lacked a clear transition threshold.
AB - Rationale: A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was characterized as a distinct ARDS phenotype. Objectives: To determine whether such Crs-based phenotypes existed among patients with ARDS before the COVID-19 pandemic and to closely examine the Crs-mortality relationship. Methods: We undertook a secondary analysis of patients with ARDS, who were invasively ventilated on controlled modes and enrolled in a large, multinational, epidemiological study. We assessed Crs, degree of hypoxemia, and associated Crs-based phenotypic patterns with their characteristics and outcomes. Measurements and Main Results: Among 1,117 patients with ARDS who met inclusion criteria, the median Crs was 30 (interquartile range, 23-40) ml/cm H
2O. One hundred thirty-six (12%) patients had preserved Crs (>50 ml/cm H
2O; phenotype with low elastance [“phenotype L”]), and 827 (74%) patients had poor Crs (,40 ml/cm H
2O; phenotype with high elastance [“phenotype H”]). Compared with those with phenotype L, patients with phenotype H were sicker and had more comorbidities and higher hospital mortality (32% vs. 45%; P, 0.05). A near complete dissociation between Pa
O2/FI
O2 and Crs was observed. Of 136 patients with phenotype L, 58 (43%) had a Pa
O2/FI
O2 , 150. In a multivariable-adjusted analysis, the Crs was independently associated with hospital mortality (adjusted odds ratio per ml/cm H
2O increase, 0.988; 95% confidence interval, 0.979-0.996; P = 0.005). Conclusions: A wide range of Crs was observed in non-COVID-19 ARDS. Approximately one in eight patients had preserved Crs. Pa
O2/FI
O2 and Crs were dissociated. Lower Crs was independently associated with higher mortality. The Crs-mortality relationship lacked a clear transition threshold.
KW - acute respiratory distress syndrome
KW - phenotype
KW - respiratory system compliance
KW - intensive care
KW - mechanical ventilation
KW - Acute respiratory distress syndrome
KW - Intensive care
KW - Phenotype
KW - Respiratory system compliance
KW - Mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85092397896&partnerID=8YFLogxK
U2 - 10.1164/rccm.202005-2046OC
DO - 10.1164/rccm.202005-2046OC
M3 - Article
C2 - 32805143
SN - 1073-449X
VL - 202
SP - 1244
EP - 1252
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 9
ER -