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Article ; Online: 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

American journal of respiratory and critical care medicine

2020 Volume 201, Issue 12, Page(s) 1560–1564

MeSH term(s)	Administration, Inhalation ; Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Coronavirus Infections/therapy ; Diabetes Mellitus/epidemiology ; Extracorporeal Membrane Oxygenation ; Female ; Fluid Therapy ; Humans ; Hypertension/epidemiology ; Lung Diseases/epidemiology ; Male ; Middle Aged ; Pandemics ; Patient Positioning/methods ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/therapy ; Positive-Pressure Respiration ; Prone Position ; Pulmonary Gas Exchange/physiology ; Renal Insufficiency/epidemiology ; Renal Insufficiency/therapy ; Renal Replacement Therapy ; Respiration, Artificial/methods ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/therapy ; Respiratory Insufficiency/epidemiology ; Respiratory Insufficiency/physiopathology ; Respiratory Insufficiency/therapy ; Respiratory Mechanics/physiology ; SARS-CoV-2 ; Smoking/epidemiology ; Vasoconstrictor Agents/therapeutic use ; Vasodilator Agents/therapeutic use ; Young Adult
Chemical Substances	Vasoconstrictor Agents ; Vasodilator Agents
Keywords	covid19
Language	English
Publishing date	2020-04-28
Publishing country	United States
Document type	Letter
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202004-1163LE
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Article: 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

Am J Respir Crit Care Med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #155108
Database	COVID19

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Article: Respiratory Pathophysiology of Mechanically Ventilated COVID-19 Patients.

Khalil, Anas / Aljohani, Atif / Alemam, Bashayer / Alshangiti, Fardus / Jeddo, Fatmah A / Albadi, Hayam / Alshanqiti, Hind M / Almughazzawi, Raghad

Cureus

2021 Volume 13, Issue 12, Page(s) e20218

Abstract: ... cohort study was conducted on adult COVID-19 patients with ARDS who needed mechanical ventilation in the ICU ... mechanics in mechanically ventilated COVID-19 patients with ARDS. Methodology An observational retrospective ... of the respiratory system that can lead to acute respiratory distress syndrome (ARDS). The pathophysiology of COVID-19 ARDS ...

Abstract	Background and objectives Coronavirus disease 2019 (COVID-19) is mainly a disease of the respiratory system that can lead to acute respiratory distress syndrome (ARDS). The pathophysiology of COVID-19 ARDS and consequently its management is a disputable subject. Early COVID-19 investigators hypothesized that the pathogenesis of COVID-19 ARDS is different from the usual ARDS. The aim of this study was to describe the lung mechanics in mechanically ventilated COVID-19 patients with ARDS. Methodology An observational retrospective cohort study was conducted on adult COVID-19 patients with ARDS who needed mechanical ventilation in the ICU of Ohoud Hospital, Madinah, KSA, from June to September 2020. Data were collected from the patients' medical charts and electronic medical records and analyzed using Statistical Package for the Social Sciences (SPSS) software package version 22 (IBM Corp., Armonk, NY) for descriptive statistical analysis. Measurements and main results A total of 52 patients were analyzed: on intubation, the median positive end-expiratory pressure (PEEP) was 10 cm H
Language	English
Publishing date	2021-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20218
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Article ; Online: Comprehensive bronchoalveolar lavage characterization in COVID-19 associated acute respiratory distress syndrome patients: a prospective cohort study.

Calabrese, Fiorella / Lunardi, Francesca / Baldasso, Elisa / Pezzuto, Federica / Kilitci, Asuman / Olteanu, Gheorghe-Emilian / Del Vecchio, Claudia / Fortarezza, Francesco / Boscolo, Annalisa / Schiavon, Marco / Vedovelli, Luca / Cattelan, Annamaria / Gregori, Dario / Rea, Federico / Navalesi, Paolo

Respiratory research

2023 Volume 24, Issue 1, Page(s) 152

Abstract: ... in comparison to those of other invasively mechanically ventilated patients (24). In CARDS patients, BAL ... COVID-19-related acute respiratory distress syndrome (CARDS) is associated with high mortality ... inflammatory signature, and respiratory pathogens in bronchoalveolar lavage (BAL) of CARDS patients (16 ...

Abstract	COVID-19-related acute respiratory distress syndrome (CARDS) is associated with high mortality rates. We still have limited knowledge of the complex alterations developing in the lung microenvironment. The goal of the present study was to comprehensively analyze the cellular components, inflammatory signature, and respiratory pathogens in bronchoalveolar lavage (BAL) of CARDS patients (16) in comparison to those of other invasively mechanically ventilated patients (24). In CARDS patients, BAL analysis revealed: SARS-CoV-2 infection frequently associated with other respiratory pathogens, significantly higher neutrophil granulocyte percentage, remarkably low interferon-gamma expression, and high levels of interleukins (IL)-1β and IL-9. The most important predictive variables for worse outcomes were age, IL-18 expression, and BAL neutrophilia. To the best of our knowledge, this is the first study that was able to identify, through a comprehensive analysis of BAL, several aspects relevant to the complex pathophysiology of CARDS.
MeSH term(s)	Humans ; Prospective Studies ; Bronchoalveolar Lavage Fluid ; COVID-19/diagnosis ; SARS-CoV-2 ; Bronchoalveolar Lavage ; Pneumonia ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/metabolism
Language	English
Publishing date	2023-06-09
Publishing country	England
Document type	Letter
ZDB-ID	2041675-1
ISSN	1465-993X ; 1465-993X
ISSN (online)	1465-993X
ISSN	1465-993X
DOI	10.1186/s12931-023-02464-9
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Article ; Online: Obesity and Critical Illness in COVID-19: Respiratory Pathophysiology.

Wolf, Molly / Alladina, Jehan / Navarrete-Welton, Allison / Shoults, Benjamin / Brait, Kelsey / Ziehr, David / Malhotra, Atul / Hardin, C Corey / Hibbert, Kathryn A

Obesity (Silver Spring, Md.)

2021 Volume 29, Issue 5, Page(s) 870–878

Abstract: ... Conclusions: In this cohort of critically ill patients with COVID-19, obesity was not associated ... In this retrospective study, the first 277 consecutive patients admitted to Massachusetts General Hospital ICUs ... in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness ...

Abstract	Objective: Recent cohort studies have identified obesity as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness in COVID-19, the association of BMI with baseline demographic and intensive care unit (ICU) parameters, laboratory values, and outcomes in a critically ill patient cohort was examined. Methods: In this retrospective study, the first 277 consecutive patients admitted to Massachusetts General Hospital ICUs with laboratory-confirmed COVID-19 were examined. BMI class, initial ICU laboratory values, physiologic characteristics including gas exchange and ventilatory mechanics, and ICU interventions as clinically available were measured. Mortality, length of ICU admission, and duration of mechanical ventilation were also measured. Results: There was no difference found in respiratory system compliance or oxygenation between patients with and without obesity. Patients without obesity had higher initial ferritin and D-dimer levels than patients with obesity. Standard acute respiratory distress syndrome management, including prone ventilation, was equally distributed between BMI groups. There was no difference found in outcomes between BMI groups, including 30- and 60-day mortality and duration of mechanical ventilation. Conclusions: In this cohort of critically ill patients with COVID-19, obesity was not associated with meaningful differences in respiratory physiology, inflammatory profile, or clinical outcomes.
MeSH term(s)	Aged ; Body Mass Index ; COVID-19/complications ; COVID-19/epidemiology ; Critical Illness ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Massachusetts ; Middle Aged ; Obesity/complications ; Respiration, Artificial ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-03-31
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2230457-5
ISSN	1930-739X ; 1071-7323 ; 1930-7381
ISSN (online)	1930-739X
ISSN	1071-7323 ; 1930-7381
DOI	10.1002/oby.23142
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Article ; Online: Clinical features and respiratory pathophysiology of COVID-19 patients ventilated in the prone position: a cohort study.

A Sastre, José / López, Teresa / M Vaquero-Roncero, Luis / E Sánchez-Barrado, María / A Martín-Moreno, María / Arribas, Pilar / Hernández, Azucena / Garrido-Gallego, Isabel / V Sánchez-Hernández, Miguel

Anaesthesiology intensive therapy

2022 Volume 53, Issue 4, Page(s) 319–324

Abstract: ... an observational study in consecutive, mechanically ventilated COVID-19 patients. The primary endpoint was ... in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). We describe ... after 72 h.: Conclusions: In our study, the COVID-19 patients with respiratory failure presented ...

Title translation	Clinical features and respiratory pathophysiology of COVID-19 patients ventilated in the prone position: a cohort study.
Abstract	Introduction: There are few studies that have investigated the response to the prone position in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). We describe the characteristics and outcomes of those patients in a tertiary hospital in Spain. Material and methods: This is an observational study in consecutive, mechanically ventilated COVID-19 patients. The primary endpoint was to describe the respiratory pathophysio-logy and clinical outcomes of COVID-19 patients treated by mechanical ventilation in the prone position. Results: Of 84 patients mechanically ventilated in the prone position, 19 (22%) were successfully extubated and 43 (51%) were discharged from the ICU. The duration of mechanical ventilation and ICU length of stay were 11 days (IQR 8-16) and 15 days (IQR 9-25), respectively. On admission to ICU, 61% patients had a moderate ARDS according to the Berlin criteria. 76% had 4 lung quadrants affected. After intubation, the median PaO2/FiO2 was 105 (IQR 76-138), ventilatory ratio was 1.48 (IQR 1.16-1.88), and compliance was 33 mL cm H 2 O-1 (IQR 25-41). The median number of cycles in the prone position was 2 (1-3), with a median of total hours in the prone position of 76 (IQR 64-111).72 h after the first prone position cycle the median PaO2/FiO2 increase was up to 193 (IQR 152-251), but the compliance was similar to the basal level (34 mL cm H 2 O-1 [IQR 26-43]). However, the percentage of patients with normal compliance (> 50 mL cm H 2 O-1) increased with the prone position from 15% (n = 13) to 32% (n = 27) after 72 h. Conclusions: In our study, the COVID-19 patients with respiratory failure presented respiratory mechanics, gas exchange parameters, and a response to prone ventilation similar to those observed in other causes of ARDS.
MeSH term(s)	COVID-19/complications ; COVID-19/therapy ; Cohort Studies ; Humans ; Prone Position ; Respiration, Artificial ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; SARS-CoV-2
Language	English
Publishing date	2022-03-08
Publishing country	Poland
Document type	Journal Article ; Observational Study
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2021.109392
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Article ; Online: Mortality in patients with COVID-19 versus non-COVID-19- related acute respiratory distress syndrome: A single center retrospective observational cohort study.

Hsieh, Yu-Hsiang / Chang, Hou-Tai / Wang, Ping-Huai / Chang, Mei-Yun / Hsu, Han-Shui

PloS one

2023 Volume 18, Issue 6, Page(s) e0286564

Abstract: ... observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive ... The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress ... in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non ...

Abstract	The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) varies from other pneumonia-related ARDS. We evaluated whether the mortality rates differed for COVID-19 and non-COVID-19-related ARDS in the Asian population in 2021. This single center retrospective observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included hospital length of stay, ICU length of stay, duration of mechanical ventilation, and ventilator-free days (VFDs) during the first 28 days. A 1:1 propensity score matching was performed to correct potential confounders by age, obesity or not, and ARDS severity. One-hundred-and-sixty-four patients fulfilled the inclusion criteria. After 1:1 propensity score matching, there were 50 patients in each group. The all-cause in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non-COVID-19-related ARDS (17 [34%) vs. 21 [42%], p = 0.410). Both groups had length of stay (30.0 [20.0-46.0] vs. 27.0 [13.0-45.0] days, p = 0.312), ICU length of stay (19.0 [13.0-35.0] vs. 16.0 [10.0-32.0] days, p = 0.249), length of mechanical ventilation (19.0 [10.0-36.0] vs. 14.0 [9.0-29.0] days, p = 0.488), and ventilator-free days during the first 28 days (5.5 [0.0-17.0] vs. 0.0 [0.0-14.0] days, p = 0.320). Immunocompromised status (Hazard ratio: 3.63; 95% CI: 1.51-8.74, p = 0.004) and progress to severe ARDS (Hazard ratio: 2.92; 95% CI: 1.18-7.22, p = 0.020) were significant in-hospital mortality-related confounders. There were no significant difference in mortality among both groups. Immunocompromised status and progression to severe ARDS are two possible risk factors for patients with ARDS; COVID-19 is not a mortality-related risk exposure.
MeSH term(s)	Humans ; COVID-19/complications ; Retrospective Studies ; Respiratory Distress Syndrome ; Respiration, Artificial ; Hospital Mortality
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286564
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Article ; Online: Biomarker Signatures of Severe Acute Kidney Injury in a Critically Ill Cohort of COVID-19 and Non-COVID-19 Acute Respiratory Illness.

Sathe, Neha A / Mostaghim, Ana / Barnes, Elizabeth / O'Connor, Nicholas G / Sahi, Sharon K / Sakr, Sana S / Zahlan, Jana M / Smith, Craig H / Fitzpatrick, Michael / Morrell, Eric D / Liles, W Conrad / Bhatraju, Pavan K

Critical care explorations

2023 Volume 5, Issue 7, Page(s) e0945

Abstract: ... participants: Prospective observational cohort study enrolling March 2020 through May 2021, at three hospitals ... immune activation, were associated with higher risk for severe AKI after adjustment for age, sex, COVID-19, and ... in a large academic health system. We analyzed 301 patients admitted to an ICU with acute respiratory illness ...

Abstract	Kidney and lung injury are closely inter-related during acute respiratory illness, but the molecular risk factors that these organ injuries share are not well defined. Objectives: We identified plasma biomarkers associated with severe acute kidney injury (AKI) during acute respiratory illness, and compared them to biomarkers associated with severe acute respiratory failure (ARF). Design settings and participants: Prospective observational cohort study enrolling March 2020 through May 2021, at three hospitals in a large academic health system. We analyzed 301 patients admitted to an ICU with acute respiratory illness. Main outcomes and measures: Outcomes were ascertained between ICU admission and day 14, and included: 1) severe AKI, defined as doubling of serum creatinine or new dialysis and 2) severe ARF, which included new or persistent need for high-flow oxygen or mechanical ventilation. We measured biomarkers of immune response and endothelial function, pathways related to adverse kidney and lung outcomes, in plasma collected within 24 hours of ICU admission. Severe AKI occurred in 48 (16%), severe ARF occurred in 147 (49%), and 40 (13%) patients experienced both. Two-fold higher concentrations of soluble tumor necrosis factor receptor-1 (sTNFR-1) (adjusted relative risk [aRR], 1.56; 95% CI, 1.24-1.96) and soluble triggering receptor on myeloid cells-1 (sTREM-1) (aRR, 1.85; 95% CI, 1.42-2.41), biomarkers of innate immune activation, were associated with higher risk for severe AKI after adjustment for age, sex, COVID-19, and Acute Physiology and Chronic Health Evaluation-III. These biomarkers were not significantly associated with severe ARF. Soluble programmed cell death receptor-1 (sPDL-1), a checkpoint pathway molecule, as well as soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule-1 (sVCAM-1), molecules involved with endothelial-vascular leukocyte adhesion, were associated with both severe AKI and ARF. Conclusions and relevance: sTNFR-1 and sTREM-1 were linked strongly to severe AKI during respiratory illness, while sPDL-1, sICAM-1 and sVCAM-1 were associated with both severe AKI and ARF. These biomarker signatures may shed light on pathophysiology of lung-kidney interactions, and inform precision medicine strategies for identifying patients at high risk for these organ injuries.
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000945
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Article ; Online: Mortality in patients with COVID-19 versus non-COVID-19- related acute respiratory distress syndrome

Yu-Hsiang Hsieh / Hou-Tai Chang / Ping-Huai Wang / Mei-Yun Chang / Han-Shui Hsu

PLoS ONE, Vol 18, Iss 6, p e

A single center retrospective observational cohort study.

2023 Volume 0286564

Abstract	The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) varies from other pneumonia-related ARDS. We evaluated whether the mortality rates differed for COVID-19 and non-COVID-19-related ARDS in the Asian population in 2021. This single center retrospective observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included hospital length of stay, ICU length of stay, duration of mechanical ventilation, and ventilator-free days (VFDs) during the first 28 days. A 1:1 propensity score matching was performed to correct potential confounders by age, obesity or not, and ARDS severity. One-hundred-and-sixty-four patients fulfilled the inclusion criteria. After 1:1 propensity score matching, there were 50 patients in each group. The all-cause in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non-COVID-19-related ARDS (17 [34%) vs. 21 [42%], p = 0.410). Both groups had length of stay (30.0 [20.0-46.0] vs. 27.0 [13.0-45.0] days, p = 0.312), ICU length of stay (19.0 [13.0-35.0] vs. 16.0 [10.0-32.0] days, p = 0.249), length of mechanical ventilation (19.0 [10.0-36.0] vs. 14.0 [9.0-29.0] days, p = 0.488), and ventilator-free days during the first 28 days (5.5 [0.0-17.0] vs. 0.0 [0.0-14.0] days, p = 0.320). Immunocompromised status (Hazard ratio: 3.63; 95% CI: 1.51-8.74, p = 0.004) and progress to severe ARDS (Hazard ratio: 2.92; 95% CI: 1.18-7.22, p = 0.020) were significant in-hospital mortality-related confounders. There were no significant difference in mortality among both groups. Immunocompromised status and progression to severe ARDS are two possible risk factors for patients with ARDS; COVID-19 is not a mortality-related risk exposure.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Mortality in patients with COVID-19 versus non-COVID-19- related acute respiratory distress syndrome

Yu-Hsiang Hsieh / Hou-Tai Chang / Ping-Huai Wang / Mei-Yun Chang / Han-Shui Hsu

PLoS ONE, Vol 18, Iss

A single center retrospective observational cohort study

2023 Volume 6

Abstract	The pathophysiology of coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) varies from other pneumonia-related ARDS. We evaluated whether the mortality rates differed for COVID-19 and non-COVID-19-related ARDS in the Asian population in 2021. This single center retrospective observational cohort study included patients with COVID-19 and non-COVID-19-related ARDS that required invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included hospital length of stay, ICU length of stay, duration of mechanical ventilation, and ventilator-free days (VFDs) during the first 28 days. A 1:1 propensity score matching was performed to correct potential confounders by age, obesity or not, and ARDS severity. One-hundred-and-sixty-four patients fulfilled the inclusion criteria. After 1:1 propensity score matching, there were 50 patients in each group. The all-cause in-hospital mortality of all patients was 38 (38%), and no significant differences were found between COVID-19 and non-COVID-19-related ARDS (17 [34%) vs. 21 [42%], p = 0.410). Both groups had length of stay (30.0 [20.0–46.0] vs. 27.0 [13.0–45.0] days, p = 0.312), ICU length of stay (19.0 [13.0–35.0] vs. 16.0 [10.0–32.0] days, p = 0.249), length of mechanical ventilation (19.0 [10.0–36.0] vs. 14.0 [9.0–29.0] days, p = 0.488), and ventilator-free days during the first 28 days (5.5 [0.0–17.0] vs. 0.0 [0.0–14.0] days, p = 0.320). Immunocompromised status (Hazard ratio: 3.63; 95% CI: 1.51–8.74, p = 0.004) and progress to severe ARDS (Hazard ratio: 2.92; 95% CI: 1.18–7.22, p = 0.020) were significant in-hospital mortality-related confounders. There were no significant difference in mortality among both groups. Immunocompromised status and progression to severe ARDS are two possible risk factors for patients with ARDS; COVID-19 is not a mortality-related risk exposure.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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