Altered static respiratory compliance under invasive mechanical ventilation in SARS-CoV-2 infection in the...

Development of respiratory sequelae in COVID-19 associated acute respiratory distress syndrome (ARDS) may occur after a fluctuating period but its physiopathology is not fully understood. Impaired static respiratory compliance (C_RS) in COVID-19 associated ARDS (CARDS), is a risk factor of mortality. However, its predictive role in the development of respiratory sequelae is unknown. The main objective was to determine if initial C_RS was associated with the development of long-term respiratory sequelae.

In this observational single-center retrospective cohort, patients had a systematic evaluation at three, six and/or twelve months after intensive care unit hospitalization for CARDS. The primary outcome was the presence of COVID-19 respiratory sequelae.

Out of the 75 patients included, 57 (76.0 %) had respiratory sequelae. Median C_RS on the first day of invasive mechanical ventilation was 38.0 [32.0-47.0] ml/cmH₂O. After adjustment for confounding factors, it was not associated with the risk of developing respiratory sequelae [OR 1.0 (CI 95 % 1.0-1.1, p = 0.5980)]. Nevertheless, between the first and tenth day of invasive ventilation, the C_RS of patients with respiratory sequelae worsened (slope: 0.11, p = 0.7570), while that of patients without respiratory sequelae improved (slope: 0.90, p = 0.0623). Multivariate analysis revealed a significant association between respiratory sequelae and age (p = 0.0474), as well as the presence of ventilator-associated pneumonia (p = 0.0125).

C_RS value on the first day of invasive mechanical ventilation was not associated with the risk of developing respiratory sequelae. However, attention should be paid to age, ventilator-associated pneumonia and C_RS evolution, to detect patients most at risk of respiratory sequelae.