Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

Abstract

Aim. The aim was to analyze the results of intensive care for COVID-19 associated acute respiratory distress syndrome (ARDS) using optimized tactical aspects of respiratory support. Methods. In this prospective study, the comparison group included 436 consecutive patients admitted to the ICU of "A-block Zangiota-1" in the period from January 1, 2021 to June 30, 2021 (taking into account the representativeness of the main group), whose the therapeutic and tactical aspects of management were based on the first own experience with results analysis across organizational and therapeutic approaches. The main group included 288 patients admitted from July 1, 2021 to October 1, 2021, whose therapeutic and tactical aspects of management were developed on the basis of a fundamental revision of the differential diagnosis, pathomorphological classification and respiratory mechanics of COVID-19 associated ARDS, as well as taking into account the influence of risk factors for the severe course of the disease and various methods and technologies of respiratory support. Accordingly, adapted and optimized respiratory therapy standards have been applied in main group. Results. The frequency of intubations and transfers to mechanical ventilation had no statistical difference between the groups (p=0.362). In the main group, cases of tracheostomy (73.8%) were significantly (p<0.001) more than the comparison group (14.5%). In the comparison group, the proportion of patients with severe ARDS decreased from 29.6% to 23.8% (p=0.067), and in the main group from 31.0% to 17.0% (p<0.001). The average duration of treatment of patients in the ICU was 22 (from 7 to 32) days in the comparison group and 17 (from 9 to 27) days in the main group (p<0.05). The frequency of deaths in COVID-19 associated ARDS was 11.1% in the main group, which was significantly lower (p=0.036) than the comparison group (16.7%). Among patients on invasive mechanical ventilation (intubation and tracheostomy), the mortality rate was 96.0% in the comparison group and 76.2% in the main group of patients (p = 0.003). Conclusion. Providing respiratory support for COVID-19 associated ARDS, taking into account the individual characteristics of respiratory mechanics, can improve the results of treatment of patients with an increase in the oxygenation index, a decrease in the proportion of cases of severe ARDS, and reduce the mortality rate and the length of stay of patients in the ICU.