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Title: Association of Time-Varying Intensity of Ventilation With Mortality in Patients With COVID-19 ARDS: Secondary Analysis of the PRoVENT-COVID Study.
Austin Authors: Schuijt, Michiel T U;van Meenen, David M P;Martin-Loeches, Ignacio;Mazzinari, Guido;Schultz, Marcus J;Paulus, Frederique;Serpa Neto, Ary 
Affiliation: Intensive Care
Data Analytics Research and Evaluation (DARE) Centre
Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland
Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Pãulo, Brazil
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC, Australia
Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Issue Date: 18-Nov-2021
Date: 2021
Publication information: Frontiers in Medicine 2021; 8: 725265
Abstract: Background: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID-19). We investigated the association of exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients. Methods: PRoVENT-COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID-19 patients under invasive ventilation for ARDS. Dynamic ΔP and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28-day mortality. To assess the effects of time-varying exposure, Bayesian joint models adjusted for confounders were used. Results: Of 1,122 patients included in the PRoVENT-COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in ΔP (HR 1.04, 95% CrI 1.01-1.07) and in MP (HR 1.12, 95% CrI 1.01-1.36). In sensitivity analyses, cumulative exposure to higher levels of ΔP or MP resulted in increased risks for 28-day mortality. Conclusion: Cumulative exposure to higher intensities of ventilation in COVID-19 patients with ARDS have an association with increased risk of 28-day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients. Clinical Trial Registration:, identifier: NCT04346342.
DOI: 10.3389/fmed.2021.725265
ORCID: 0000-0003-1520-9387
Journal: Frontiers in Medicine
PubMed URL: 34869421
PubMed URL:
ISSN: 2296-858X
Type: Journal Article
Subjects: acute respiratory distress syndrome
coronavirus disease 2019
driving pressure
mechanical power
Appears in Collections:Journal articles

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