Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study

• DOI: 10.1186/s13613-020-00716-1
• Publication Date: 2020-07-16T10:03:28Z
• Authors: J.-L. Diehl; N. Peron; R. Chocron; B. Debuc; E. Guerot; C. Hauw-Berlemont; B. Hermann; J. L. Augy; R. Younan; A. Novara; J. Langlais; L. Khider; N. Gendron; G. Goudot; J.-F. Fagon; T. Mirault; D. M. Smadja
• Keywords: Respiratory physiology; Pulmonary compliance

Abstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features respiratory failure. Our aim was to study pulmonary mechanics gas exchanges in COVID-2019 patients studied early after initiating protective invasive mechanical ventilation, seeking corresponding pathophysiological biological characteristics. Methods Between March 22 30, 2020 mechanics, exchanges, circulating endothelial cells (CEC) markers damage, D-dimers were moderate-to-severe patients, 1 [1–4] day intubation (median [IQR]). Measurements main results Thirteen moderate 9 severe initiation high PEEP ventilation. We observed moderately decreased system compliance: 39.5 [33.1–44.7] mL/cmH 2 O end-expiratory lung volume: 2100 [1721–2434] mL. Gas characterized by hypercapnia 55 [44–62] mmHg, physiological dead-space ( V D / T ): 75 [69–85.5] % ventilatory ratio (VR): 2.9 [2.2–3.4]. VR significantly correlated: r = 0.24, p 0.014. No embolism suspected at time measurements. CECs elevated compared normal values: 24 [12–46] per mL 1483 [999–2217] ng/mL, respectively. Conclusions course association with damage thrombosis. High can be explained settings added instrumental dead space, a possible associated role COVID-19-triggered microthrombotic process.