Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic
Date
2020
Authors
Panwar, Rakshit
Madotto, Fabiana
Laffey, John
Van Haren, Frank
Journal Title
Journal ISSN
Volume Title
Publisher
American Thoracic Society
Abstract
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 Crswas characterized as a distinctARDS 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 H2O. One hundred thirty-six
(12%) patients had preserved Crs (>50 ml/cm H2O; phenotype
with low elastance [“phenotype L”]), and 827 (74%) patients had poor
Crs (,40 ml/cm H2O; 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 PaO2
/FIO2 and Crs was observed. Of 136
patients with phenotype L, 58 (43%) had a PaO2
/FIO2 , 150. In a
multivariable-adjusted analysis, the Crs was independently
associated with hospital mortality (adjusted odds ratio per ml/cm
H2O 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.
PaO2
/FIO2 and Crs were dissociated. Lower Crs was independently
associated with higher mortality. The Crs–mortality relationship
lacked a clear transition threshold.
Description
Keywords
acute respiratory distress syndrome, phenotype, respiratory system compliance, intensive care, mechanical ventilation
Citation
Collections
Source
American Journal of Respiratory and Critical Care Medicine
Type
Journal article
Book Title
Entity type
Access Statement
Open Access
License Rights
Restricted until
Downloads
File
Description