Ventilatory Ratio in Hypercapnic Mechanically Ventilated Patients with COVID-19–associated Acute Respiratory Distress Syndrome

Liu, Xiaoqing; Liu, Xuesong; Xu, Yonghao; Xu, Zhiheng; Huang, Yongbo; Chen, Sibei; Li, Shiyue; Liu, Dongdong; Lin, Zhihua; Li, Yimin

doi:10.1164/rccm.202002-0373le

Cited by 85 publications

(95 citation statements)

References 8 publications

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“…Moreover, a recent study using standardized protective ventilation settings in COVID‐19 patients confirmed that oxygenation was severely compromised with a moderate alteration in the respiratory system compliance. Hypercapnia high prevalence led to the hypothesis of a large amount of ventilated/not perfused alveoli, which could reflect diffuse microthrombi in the pulmonary microvascular bed 25 . In renal disease associated to COVID‐19, thrombotic lesions were proposed, because high D‐dimers were more commonly observed in patients with elevated baseline serum creatinine 9 .…”

Section: Discussionmentioning

confidence: 99%

Curative anticoagulation prevents endothelial lesion in COVID‐19 patients

Khider

Gendron

Goudot

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Coronavirus disease‐2019 (COVID‐19) has been associated with cardiovascular complications and coagulation disorders. Objectives To explore the coagulopathy and endothelial dysfunction in COVID‐19 patients. Methods The study analyzed clinical and biological profiles of patients with suspected COVID‐19 infection at admission, including hemostasis tests and quantification of circulating endothelial cells (CECs). Results Among 96 consecutive COVID‐19‐suspected patients fulfilling criteria for hospitalization, 66 were tested positive for SARS‐CoV‐2. COVID‐19‐positive patients were more likely to present with fever (P = .02), cough (P = .03), and pneumonia at computed tomography (CT) scan (P = .002) at admission. Prevalence of D‐dimer >500 ng/mL was higher in COVID‐19‐positive patients (74.2% versus 43.3%; P = .007). No sign of disseminated intravascular coagulation were identified. Adding D‐dimers >500 ng/mL to gender and pneumonia at CT scan in receiver operating characteristic curve analysis significantly increased area under the curve for COVID‐19 diagnosis. COVID‐19‐positive patients had significantly more CECs at admission (P = .008) than COVID‐19‐negative ones. COVID‐19‐positive patients treated with curative anticoagulant prior to admission had fewer CECs (P = .02) than those without. Interestingly, patients treated with curative anticoagulation and angiotensin‐converting‐enzyme inhibitors or angiotensin receptor blockers had even fewer CECs (P = .007). Conclusion Curative anticoagulation could prevent COVID‐19‐associated coagulopathy and endothelial lesion.

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Section: Discussionmentioning

confidence: 99%

Curative anticoagulation prevents endothelial lesion in COVID‐19 patients

Khider

Gendron

Goudot

et al. 2020

Journal of Thrombosis and Haemostasis

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“…from supine to prone position). Liu et al (10) computed the ventilatory ratio as a measure of ventilatory efficiency. They found a high ventilatory ratio in hypercapnic COVID-19 patients, which decreased when tidal volume was increased from 7 ± 0.6 to 7.7 ± 0.6 mL/kg.…”

Section: Discussionmentioning

confidence: 99%

Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!

Roesthuis

Berg

Hoeven

2020

Preprint

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With the emergence of COVID-19 we are confronted with a new clinical picture of acute respiratory distress syndrome in the intensive care unit. In the majority of patients, the respiratory mechanics are very different from the “normal” ARDS patient. We measured transpulmonary pressure and dead space ventilation to assess the effects of high and low PEEP levels on lung compliance and ventilation-perfusion mismatching. Advanced respiratory mechanics were assessed in 14 patients. Compared to ARDS patients, lung compliance was relatively high (61 ± 5 mL/cmH2O). COVID-19 patients had high dead space ventilation and gas exchange impairment (Bohr 52 ± 3%; Enghoff modification 67 ± 2%; ventilatory ratio 2.24 ± 0.23). we show that higher PEEP levels decrease lung compliance and in most cases increase dead space ventilation, indicating that high PEEP levels probably cause hyperinflation in patients with COVID-19. We suggest using prone position for an extended period of time, and apply lower PEEP levels as much as possible.

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“…These observations, if confirmed, would unify observations of direct endothelial infection, endothelial inflammation or edema, and abnormal pulmonary vascular behavior, resulting in hypoxemia and elevated physiological dead space that appear to be out of proportion to radiographic evidence of diseased lung parenchyma and relatively normal lung compliance. 64 It is possible that the observed degree of hypoxemia and preserved respiratory system compliance could be within the normal distribution for ARDS physiology. 65 …”

Section: Vascular Endotheliummentioning

confidence: 99%

“…Microvascular thrombosis in lung capillaries adjacent to ventilated alveoli would result in increased dead space, which is common in ARDS and is particularly prominent in COVID-19 pneumonia. 64 …”

Section: Venous Thromboembolic Disease and Pulmonary Microvascular Thmentioning

confidence: 99%

“… 109 Potential mechanisms for excessive respiratory drive may include (but are not limited to) hypoxemia accompanied by an increased alveolar-to-arterial oxygen gradient (ie, ventilation-perfusion mismatch or intrapulmonary shunting), hypercapnia secondary to increased dead space fraction (eg, due to low tidal volume ventilation or hyperinflation), stimulation of lung and chest wall receptors, cortical stimuli, and brain stem inflammation. 64 , 65 , 110 Regarding the latter, experimental studies suggest that viral invasion of the olfactory nerve progression into the brain stem respiratory centers could be a potential mechanism for central nervous system involvement in the manifestation of respiratory failure related to coronaviruses. 111 Although evidence regarding SARS-CoV-2 is still scarce, coronavirus infections in the brain have been described before in both animal and human studies.…”

Section: Disorders Of Control Of Breathing and The Neuromuscular Breamentioning

confidence: 99%

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COVID-19 and Respiratory System Disorders

Brosnahan

Jonkman

Kugler

et al. 2020

ATVB

116

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The severe acute respiratory syndrome coronavirus-2 emerged as a serious human pathogen in late 2019, causing the disease coronavirus disease 2019 (COVID-19). The most common clinical presentation of severe COVID-19 is acute respiratory failure consistent with the acute respiratory distress syndrome. Airway, lung parenchymal, pulmonary vascular, and respiratory neuromuscular disorders all feature in COVID-19. This article reviews what is known about the effects of severe acute respiratory syndrome coronavirus-2 infection on different parts of the respiratory system, clues to understanding the underlying biology of respiratory disease, and highlights current and future translation and clinical research questions.

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Ventilatory Ratio in Hypercapnic Mechanically Ventilated Patients with COVID-19–associated Acute Respiratory Distress Syndrome

Cited by 85 publications

References 8 publications

Curative anticoagulation prevents endothelial lesion in COVID‐19 patients

Curative anticoagulation prevents endothelial lesion in COVID‐19 patients

Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!

COVID-19 and Respiratory System Disorders

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