Influence of age, mechanical power, its fragments and components on the mortality rate in SARS-CoV-2 patients undergoing mechanical ventilation

Abstract

Introduction The Acute Respiratory Distress Syndrome caused by the Coronavirus 2019 (SARS-CoV-2) may be associated with the Acute Respiratory Distress Syndrome (ARDS) and Ventilation Induced Lung Injury (VILI). However, there are still doubts about the potential damage generators and their influences on patient outcome. Objective To analyze the mechanical ventilation factors that influence the mortality in SARS-CoV-2. Assess the outcomes based on age, on parameters of the mechanical ventilator, on Mechanical Power and on its fragments through univariate and multivariate analysis of age, PEEP, Driving Pressure, elastance. Method Observational, longitudinal, prospective, analytical, and quantitative study of age and of the parameters of the mechanical ventilator, alongside the calculous of the Mechanical Power and its components of patients with SARS-CoV-2. Results We identified significant impact on the outcome in the univariate analysis of age (p<0.001), respiratory rate (p=0.047), elastance (p<0.001), compliance (p<0.001), driving pressure (p<0.001), inspiratory pressure variation (p<0.001), peak airway pressure (p=0.009), plateau pressure (p<0.013), PEEP (p<0.001), dynamic elastic power (p<0.001) and static elastic power (p=0.005). In the multivariate analysis the increase in age (p<0.001), in elastance (p=0.0029) and in Mechanical Power (p=0.023), and the reduction in PEEP (p=0.044) showed significant impact on the death risk. Conclusion The increase in age and in mechanical power with increased dynamic elastic power and decreased static elastic power influenced the mortality rate of patients with SARS-CoV-2 undergoing mechanical ventilation, i.e. it is related to the increase in driving pressure to overcome a high elastance and low capacity to recruit for PEEP.