Outcomes of acute respiratory distress syndrome in COVID-19 patients compared to the general population: a systematic review and meta-analysis

Dmytriw, Adam A; Chibbar, Richa; Chen, Petty Pin Yu; Traynor, Michael D.; Kim, Dong Wook; Bruno, Fernando; Cheung, Christopher C.; Pareek, Anuj; Chou, Andrew Chia Chen; Graham, Jeffrey; Dibas, Mahmoud; Paranjape, Geeta; Reierson, Natalie L.; Kamrowski, Shelby; Rozowsky, Jacob S; Barrett, Averi; Schmidt, Megan; Shahani, Disha; Cowie, Kathryn; Davis, Amber R.; Abdelmegeed, Mohamed A.; Touchette, Jillienne C.; Kallmes, Kevin M.; Pederson, John M.; Keesari, Praneeth Reddy

doi:10.1080/17476348.2021.1920927

Cited by 20 publications

(19 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Such a high rate of mortality is consistent with rates reported elsewhere, including one study in which 96.6% of mechanically-ventilated COVID-19 patients perished(23). We again point out the limitations of the one recently-published meta-analysis which failed to detect any signi cant differences in mortality comparing COVID-19 and non-COVID patients with ARDS(17), limitations which included the inclusion of six (out of ten) studies using historical, rather than contemporary non-COVID cases, ve using retrospectively-collected data on COVID-19 patients, two analysing data from emergency department rather than ICU patients, and two restricting their analysis to just mechanically-ventilated or ECMO patients.…”

supporting

confidence: 90%

“…In yet another meta-analysis comparing COVID and non-COVID ARDS patients (17), the focus again was only on outcomes, and only one of the ten analysed studies directly compared these two patient groups in an ICU setting(18). Of the remaining nine, ve involved retrospective data collection for both COVID and non-COVID cases, six compared COVID patients against non-COVID patients extracted from historical cohorts, two were conducted in emergency departments rather than an ICU, and two studied highlyselective patient populations: one only studying mechanically-ventilated patients, and one only patients undergoing ECMO.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Comparing critically-ill ARDS patients with versus without COVID-19: Prospective analysis of 690 patients

Algethamy

Aboudeif

Alhandi

et al. 2022

Preprint

View full text Add to dashboard Cite

BACKGROUND: Few studies have directly and prospectively compared ICU patients with acute respiratory distress syndrome (1) caused by COVID-19 versus other causes, almost all previously-published studies retrospective and employing historical non-COVID cases. This study aimed to identify patient characteristics and predictors of mortality associated with COVID-related ARDS.METHODS: We performed a Prospective cohort study. Consecutive ARDS patients with versus without confirmed COVID-19 admitted to a single ICU of a major tertiary-care hospital from March-December 2020 were included. Data were collected and both bivariate and multivariable analysis performed on COVID-19 status, demographics; morphometrics; comorbidities; presenting symptoms; admission general health status (APACHE-II); respiratory and laboratory tests at admission, within 24 hours of admission, and pre-intubation; treatments administered; and outcomes. Data capture was almost 100%.RESULTS: Numerous clinical differences were detected between n=160 patients with versus n=530 patients without COVID-19. Most notably, COVID-19 patients were generally older and heavier, much more frequently presented with fevers/chills, dyspnoea, cough, anosmia/ageusia, and sore throat — and had worse outcomes, including over a two-fold rate of mortality and five-fold rate of survivors requiring prolonged supplemental oxygen. The presenting symptom dyad of fevers and/or chills and dyspnoea was 93.0% sensitive and 63.4% specific for COVID-related ARDS. A baseline APACHE-II Score ≥17 and requiring mechanical ventilation was 94.4% sensitive and 70.5% specific for mortality. All 37 COVID patients with an APACHE-II score >30 died, versus survival among non-COVID patients with APACHE-II scores up to 40.CONCLUSION: In one of the first large studies to directly compare contemporary populations of COVID-19 and non-COVID ICU patients with ARDS, employing multi-variable analysis, numerous differences in patient characteristics, presentation, and outcomes were detected.

show abstract

supporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Comparing critically-ill ARDS patients with versus without COVID-19: Prospective analysis of 690 patients

Algethamy

Aboudeif

Alhandi

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Pulmonary fibrosis related to the setting of ARDS is well recognized, with the majority of these patients developing histopathological evidence of fibrosis [9,34,42]. In view of the high prevalence of ARDS among COVID-19 pneumonia patients, the development of pulmonary fibrosis in this patient population is a concern [43,44], and chest CT imaging in this particular group of patients is advised.…”

Section: Who Should Have Imaging Follow-up?mentioning

confidence: 99%

COVID-19 pneumonia imaging follow-up: when and how? A proposition from ESTI and ESR

et al. 2021

View full text Add to dashboard Cite

This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. Key Points • Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. • At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. • Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed “fibrotic-like changes” probably consistent with prior organizing pneumonia.

show abstract

“…Since this study, the prevalence of ARDS has dramatically increased due to the COVID-19 pandemic. Mortality from COVID-19-related ARDS ranges widely (12–78%), and limited comparative data suggests similar outcomes between COVID-19-related ARDS and non-COVID-ARDS [ 75 , 76 ].…”

Section: Overview Of Ardsmentioning

confidence: 99%

Brain-Lung Crosstalk: Management of Concomitant Severe Acute Brain Injury and Acute Respiratory Distress Syndrome

Matin

Sarhadi

Crooks

et al. 2022

Curr Treat Options Neurol

View full text Add to dashboard Cite

Purpose of Review To summarize pathophysiology, key conflicts, and therapeutic approaches in managing concomitant severe acute brain injury (SABI) and acute respiratory distress syndrome (ARDS). Recent Findings ARDS is common in SABI and independently associated with worse outcomes in all SABI subtypes. Most landmark ARDS trials excluded patients with SABI, and evidence to guide decisions is limited in this population. Potential areas of conflict in the management of patients with both SABI and ARDS are (1) risk of intracranial pressure (ICP) elevation with high levels of positive end-expiratory pressure (PEEP), permissive hypercapnia due to lung protective ventilation (LPV), or prone ventilation; (2) balancing a conservative fluid management strategy with ensuring adequate cerebral perfusion, particularly in patients with symptomatic vasospasm or impaired cerebrovascular blood flow; and (3) uncertainty about the benefit and harm of corticosteroids in this population, with a mortality benefit in ARDS, increased mortality shown in TBI, and conflicting data in other SABI subtypes. Also, the widely adapted partial pressure of oxygen (P a O 2 ) target of > 55 mmHg for ARDS may exacerbate secondary brain injury, and recent guidelines recommend higher goals of 80–120 mmHg in SABI. Distinct pathophysiology and trajectories among different SABI subtypes need to be considered. Summary The management of SABI with ARDS is highly complex, and conventional ARDS management strategies may result in increased ICP and decreased cerebral perfusion. A crucial aspect of concurrent management is to recognize the risk of secondary brain injury in the individual patient, monitor with vigilance, and adjust management during critical time windows. The care of these patients requires meticulous attention to oxygenation and ventilation, hemodynamics, temperature management, and the neurological exam. LPV and prone ventilation should be utilized, and supplemented with invasive ICP monitoring if there is concern for cerebral edema and increased ICP. PEEP titration should be deliberate, involving measures of hemodynamic, pulmonary, and brain physiology. Serial volume status assessments should be performed in SABI and ARDS, and fluid management should be individualized based on measures of brain perfusion, the neurological exam, and cardiopulmonary status. More research is needed to define risks and benefits in corticosteroids in this population.

show abstract

Outcomes of acute respiratory distress syndrome in COVID-19 patients compared to the general population: a systematic review and meta-analysis

Cited by 20 publications

References 48 publications

Comparing critically-ill ARDS patients with versus without COVID-19: Prospective analysis of 690 patients

Comparing critically-ill ARDS patients with versus without COVID-19: Prospective analysis of 690 patients

COVID-19 pneumonia imaging follow-up: when and how? A proposition from ESTI and ESR

Brain-Lung Crosstalk: Management of Concomitant Severe Acute Brain Injury and Acute Respiratory Distress Syndrome

Contact Info

Product

Resources

About