Background
Methods
Study design
Patient characteristics and clinical evaluation
Echocardiography
Statistical analysis
Results
Patients’ characteristics at admission
Variable | Available/ total (%) | All patients n = 283 |
---|---|---|
Age (years) | 283/283 (100) | 67 [59;72] |
Sex (male), n (%) | 283/283 (100) | 202 (71) |
Body mass index (kg/m2) | 283/283 (100) | 29.4 [26.0;34.3] |
History of cardiac disease, n (%) | 283/283 (100) | 38 (13) |
History of chronic respiratory disease, n (%) | 283/283 (100) | 9 (3) |
Diabetes mellitus, n (%) | 283/283 (100) | 93 (33) |
Cirrhosis, n (%) | 283/283 (100) | 4 (1) |
Solid organ malignancy, n (%) | 283/283 (100) | 12 (4) |
Hematological malignancy, n (%) | 283/283 (100) | 14 (5) |
Hypertension, n (%) | 283/283 (100) | 159 (56) |
Immunosuppression, n (%) | 283/283 (100) | 43 (18) |
SARS-CoV-2 vaccination, n (%) | 191/283 (67) | 14 (7) |
SOFA score on ICU admission | 283/283 (100) | 4 [3;5] |
SAPS II | 283/283 (100) | 37 [31;43] |
Onset of symptoms to ICU admission (days) | 283/283 (100) | 8 [6;11] |
PaO2/FiO2 on admission (mmHg) | 281/283 (99) | 93 [73;120] |
PaCO2 on admission (mmHg) | 281/283 (99) | 34 [31;38] |
Respiratory rate on admission (cycles/min) | 275/283 (97) | 33 [29;38] |
Use of corticosteroids, n (%) | 283/283 (100) | 183 (65) |
Use of anti-IL6-R, n (%) | 283/283 (100) | 21 (7) |
Modality of oxygenation before invasive mechanical ventilation, n (%) | 283/283 (100) | |
Standard oxygen therapy | 32 (11) | |
High-flow oxygen therapy | 244 (86) | |
Noninvasive ventilation | 7 (3) | |
ICU admission to intubation (days) | 283/283 (100) | 1 [1;3] |
Patients’ characteristics on meeting EOLIA criteria (or at the worst PaO2/FiO2) and outcome
Variable | n (available/total) | All patients n = 283 |
---|---|---|
Clinical characteristics | ||
Time from intubation to worst PaO2/FiO2 (days) | 283/283 (100) | 2 [0;4] |
Vasopressor support, n (%) | 283/283 (100) | 95 (34) |
Inotropic support, n (%) | 283/283 (100) | 4 (1) |
PaO2/FiO2 (mmHg) | 283/283 (100) | 78 [56;94] |
PaCO2 (mmHg) | 283/283 (100) | 52 [45;62] |
pH | 283/283 (100) | 7.33 [7.32;7.38] |
Plateau pressure (cmH2O) | 263/283 (93) | 27 [24;30] |
PEEP (cmH2O) | 283/283 (100) | 10 [8;13] |
Driving pressure (cmH2O) | 263/283 (93) | 16 [13;19] |
Respiratory rate (cycle/min) | 283/283 (100) | 28 [24;32] |
Tidal volume (mL/kg PBW) | 283/283 (100) | 6.3 [5.9;7] |
Central venous pressure (mmHg) | 108/283 (38) | 10 [8;12] |
Echocardiographic findings | ||
LVEF (%) | 231/283 (82) | 59 [52;66] |
LVOT VTI (cm) | 230/283 (81) | 20.8 [17;24.2] |
E/A ratio | 214/283 (76) | 0.95 [0.77;1.17] |
RVEDA/LVEDA | 232/283 (82) | 0.74 [0.59;0.88] |
Paradoxical septal motion, n (%) | 236/283 (83) | 93 (39) |
RV fractional area change (%) | 222/283 (78) | 42 [33;48] |
Pulmonary acceleration time (ms) | 181/283 (64) | 83 [66;100] |
Characteristics of the different subgroups with their respective outcome and factors associated with 90 day mortality
Variable | EOLIA−n = 107 | EOLIA + RVI−n = 126 | EOLIA + RVI + n = 32 | p |
---|---|---|---|---|
Baseline characteristics | ||||
Sex (male), n (%) | 71 (66.4) | 92 (73.0) | 25 (78.1) | 0.340 |
Age (years) | 69 [60, 73] | 68 [60, 72] | 69 [61, 74] | 0.662 |
Body mass index (kg/m2) | 28.00 [25.00, 33.00] | 30.71 [26.52, 35.21] | 31.42 [27.92, 33.41] | 0.009 |
SOFA score at admission | 4 [3, 5] | 4 [3, 5] | 4 [4, 5] | 0.652 |
SAPS II | 36 [29, 42] | 40 [35, 47] | 36 [31, 41] | 0.001 |
Chronic respiratory failure, n (%) | 3 (2.8) | 5 (4.0) | 1 (3.1) | 0.884 |
Immunosuppression, n (%) | 22 (20.6) | 18 (14.3) | 1 (3.1) | 0.050 |
ICU admission to intubation (days) | 1 [0, 3] | 1 [0, 2] | 2 [1, 4] | 0.156 |
Intubation to compliance with EOLIA criteria or worst PaO2/FiO2 (days) | 1 [0, 2] | 2 [0,4] | 2 [1, 4] | 0.002 |
Use of prone positioning (%) | 76 (71) | 105 (83) | 26 (81) | 0.069 |
Respiratory parameters | ||||
PaO2/FiO2 (mmHg) | 100 [91, 115] | 59 [51, 70] | 59 [44, 69] | < 0.001 |
PaCO2 (mmHg) | 48 [43, 55] | 54 [46, 64] | 60 [52, 76] | < 0.001 |
pH | 7.36 [7.30, 7.41] | 7.31 [7.25, 7.36] | 7.25 [7.21, 7.33] | < 0.001 |
Plateau pressure (cmH2O) | 27 [23, 30] | 27 [24, 29] | 28 [25, 30] | 0.484 |
PEEP (cmH2O) | 12 [10, 14] | 10 [7, 12] | 9 [7, 12] | < 0.001 |
Driving pressure (cmH2O) | 14 [12, 18] | 17 [15, 20] | 18 [14, 22] | < 0.001 |
Respiratory rate (cycle/min) | 30 [25, 32] | 26 [22, 30] | 30 [26, 34] | 0.001 |
Echocardiographic findings | ||||
Shock (%)a | 29 | 46 | 11 | 0.471 |
LVEF (%) | 59 [50, 65] | 60 [52, 66] | 62 [55, 65] | 0.522 |
LVOT VTI (cm) | 20 [16, 24] | 21 [18, 24] | 18 [15, 25] | 0.177 |
RVEDA/LVEDA | 0.74 [0.60, 0.85] | 0.70 [0.58, 0.81] | 1.00 [0.93, 1.18] | < 0.001 |
RV fractional area change (%) | 44 [36, 51] | 43 [34, 48] | 36 [26,
43] | 0.007 |
Pulmonary acceleration time (ms) | 91 [72, 109] | 83 [60, 100] | 69 [50, 80] | < 0.001 |
Paradoxical septal motion, n (%) | 40 (37.7) | 21 (17.4) | 32 (100.0) | < 0.001 |