Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study

Ziehr, David R.; Alladina, Jehan; Petri, Camille R.; Maley, Jason H.; Moskowitz, Ari; Medoff, Benjamin D.; Hibbert, Kathryn A.; Thompson, B. Taylor; Hardin, C. Corey

doi:10.1164/rccm.202004-1163le

Cited by 389 publications

(492 citation statements)

References 10 publications

(7 reference statements)

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“…Individuals with moderate disease also reported a median of nine days since onset of symptoms. In accordance with a recent report (19), individuals with COVID-19 had high incidence of underlying pulmonary disease (11/35 including moderate and severe, 31.4%) and were current or former smokers (13/35 including moderate and severe, 42.7%, higher in individuals who developed severe disease).…”

Section: Demographics and Clinical Characteristics Of Moderate And Sesupporting

confidence: 90%

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Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Kuri-Cervantes

Pampena

Meng

et al. 2020

Preprint

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Although critical illness has been associated with SARS-CoV-2-induced hyperinflammation, the immune correlates of severe COVID-19 remain unclear. Here, we comprehensively analyzed peripheral blood immune perturbations in 42 SARS-CoV-2 infected and recovered individuals.We identified broad changes in neutrophils, NK cells, and monocytes during severe COVID-19, suggesting excessive mobilization of innate lineages. We found marked activation within T and B cells, highly oligoclonal B cell populations, profound plasmablast expansion, and SARS-CoV-2specific antibodies in many, but not all, severe COVID-19 cases. Despite this heterogeneity, we found selective clustering of severe COVID-19 cases through unbiased analysis of the aggregated immunological phenotypes. Our findings demonstrate broad immune perturbations spanning both innate and adaptive leukocytes that distinguish dysregulated host responses in severe SARS-CoV-2 infection and warrant therapeutic investigation.One Sentence Summary: Broad immune perturbations in severe COVID-19 surrogates, as well as the medical personnel in charge of patient care.

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Section: Demographics and Clinical Characteristics Of Moderate And Sesupporting

confidence: 90%

“…To assess the general landscape of immune responses and their perturbation during severe COVID- 19, we performed extensive immunophenotyping to characterize the frequencies of circulating immune subsets in HD, or in moderate, severe and recovered COVID-19 individuals (Fig. 1, Fig.…”

Section: Immune Perturbation In Severe Covid-19mentioning

confidence: 99%

Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Kuri-Cervantes

Pampena

Meng

et al. 2020

Preprint

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“…The observed mortality rate of 26% for patients with COVID-19 admitted in our ICU seems lower than the mortality rates of 62% and 51% reported by early studies from Wuhan, China and Washington State, USA, respectively [10,11]. Although the latter mortality rates might be exaggerated [12] and subsequent studies reported outcomes similar to ours [13], this nding is intriguing. It could be explained by the fact that the health-care system of Greece was not substantially burdened throughout the course of the COVID-19 outbreak.…”

Section: Discussioncontrasting

confidence: 51%

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

Siempos

Xourgia

Ntaidou

et al. 2020

Preprint

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Background: Optimal timing of initiation of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 is unknown. Thanks to early flattening of the epidemiological curve, ventilator demand in Greece was kept lower than supply throughout the pandemic, allowing for unbiased comparison of the outcomes of patients undergoing early intubation versus delayed or no intubation.Methods: We conducted an observational study including all adult patients with laboratory-confirmed COVID-19 consecutively admitted in Evangelismos Hospital, Athens, Greece between March 11, 2020 and April 15, 2020. Patients subsequently admitted in the intensive care unit (ICU) were categorized into the “early intubation” versus the “delayed or no intubation” group.Results: During the study period, a total of 101 patients (37% female, median age 65 years) were admitted in the hospital. Fifty-nine patients (58% of the entire cohort) were exclusively hospitalized in general wards with a mortality of 3% and median length of stay of 7 days. Forty-two patients (19% female, median age 65 years, 62% with at least one comorbidity, 14% never intubated) were admitted in the ICU; all with acute hypoxemic respiratory failure. Early intubation was not associated with higher ICU-mortality (21% versus 33%), fewer ventilator-free days (3 versus 2 days) or fewer ICU-free days than delayed or no intubation.Conclusions: A strategy of early intubation was not associated with worse clinical outcomes compared to delayed or no intubation. Given that early intubation may presumably reduce virus aerosolization, these results may justify further research with a randomized controlled trial.

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“…When a mean value of a continuous outcome was missing, methods by Wan [7] were utilized to impute the needed value for the meta-analysis. Since some studies [8,9,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] included patients still hospitalized at endpoint (n=4,697, 37.8%), we considered two mortality scenarios methodologically: (1) best case scenario by pooling patients with known outcome and (2) worst case scenario by pooling those still hospitalized with non-survivors.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 6,875 patients were on IMV. Nine studies were from the USA [8][9][10][11]17,18,23,25,26], 13 from China [12,14,16,[20][21][22][27][28][29][30][31][32][33], two from the UK [24,32], and one each from Italy [15], Spain [13], France [19], and Mexico [35]. (Table 1) Fifteen studies were good and 13 were fair as assessed by the NIH tool.…”

Section: Search Resultsmentioning

confidence: 99%

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Chang

Elhusseiny

Yeh

et al. 2020

Preprint

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Background To characterize COVID-19 ICU admissions, their outcome and associated features, as well as identify their regional discrepancies. Methods Scopus, Embase, preprint servers bioRvix and medRvix and the Intensive Care National Audit and Research Center (ICNARC) website was searched for reports through May 1st 2020 on COVID-19 ICU admissions and outcomes using pre-defined search terms and eligibility criteria.Relevant data was extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, MV mortality. Subgroup analysis was carried out based on patient regions.Results Twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21%[95% CI 0.12 to 0.34] and 69% of cases needed IMV[95% CI 0.61-0.75]. ICU and IMV mortality were 28.3%[95% CI 0.25 to 0.32], 43%[95% CI 0.29 to 0.58] and ICU, IMV duration was 7.78[95% CI 6.99 to 8.63] and 10.12[95% CI 7.08 to 13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19, major correlates with ICU mortality were found to be IMV [pOR 16.46, 95% CI 4.37 to 61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52 to 102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66 to 16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes.Conclusions This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes to date and the only analysis to analyze and associate IMV with COVID-19 ICU mortality. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as research into optimal ventilation strategies for patients. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.Study Registration PROSPERO registration number CRD42020182482.

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Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study

Cited by 389 publications

References 10 publications

Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

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Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study

Cited by 389 publications

References 10 publications

Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19&nbsp;

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

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Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19