- Title
- Compliance phenotypes in early acute respiratory distress syndrome before the COVID-19 pandemic
- Creator
- Panwar, Rakshit; Madotto, Fabiana; Laffey, John G.; van Haren, Frank M. P.
- Relation
- American Journal of Respiratory and Critical Care Medicine Vol. 202, Issue 9, p. 1244-1252
- Publisher Link
- http://dx.doi.org/10.1164/rccm.202005-2046OC
- Publisher
- American Thoracic Society
- Resource Type
- journal article
- Date
- 2020
- Description
- 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 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.
- Subject
- acute respiratory distress syndrome; phenotype; respiratory system compliance; intensive care; mechanical ventilation; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1440197
- Identifier
- uon:41102
- Identifier
- ISSN:1073-449X
- Rights
- This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/). For commercial usage and reprints, please contact Diane Gern (dgern@thoracic.org).
- Language
- eng
- Full Text
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