Compliance Phenotypes in Early Acute Respiratory Distress Syndrome before the COVID-19 Pandemic

• Published in: American journal of respiratory and critical care medicine 2020-11, Vol.202 (9), p.1244-1252
• Main Authors: Panwar, Rakshit, Madotto, Fabiana, Laffey, John G, van Haren, Frank M P
• Format: Article
• Language: English
• Subjects: Betacoronavirus; Coronavirus Infections - epidemiology; COVID-19; Female; Follow-Up Studies; Genotype & phenotype; Humans; Hypoxemia; Intensive Care Units; Lung Compliance - physiology; Male; Middle Aged; Mortality; Original; Pandemics; Pneumonia, Viral - epidemiology; Prospective Studies; Respiration; Respiratory distress syndrome; Respiratory Distress Syndrome - physiopathology; Respiratory Function Tests; SARS-CoV-2
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.202005-2046oc

A novel model of phenotypes based on set thresholds of respiratory system compliance (Crs) was recently postulated in context of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS). In particular, the dissociation between the degree of hypoxemia and Crs was characterized as a distinct ARDS phenotype. To determine whether such Crs-based phenotypes existed among patients with ARDS before the COVID-19 pandemic and to closely examine the Crs-mortality relationship. We undertook a secondary analysis of patients with ARDS, who were invasively ventilated on controlled modes and enrolled in a large, multinational, epidemiological study. We assessed Crs, degree of hypoxemia, and associated Crs-based phenotypic patterns with their characteristics and outcomes. Among 1,117 patients with ARDS who met inclusion criteria, the median Crs was 30 (interquartile range, 23-40) ml/cm H O. One hundred thirty-six (12%) patients had preserved Crs (≥50 ml/cm H O; phenotype with low elastance ["phenotype L"]), and 827 (74%) patients had poor Crs (