Impact of Corrected Minute Ventilation on Mortality in Mechanically Ventilated Patients With COVID-19-Related Acute Respiratory Distress Syndrome: A Multicenter, Observational Study Using the J-RECOVER Registry Data

TL;DR

Higher corrected minute ventilation in COVID-19 ARDS patients is linked to increased in-hospital mortality, possibly reflecting lung and vascular damage.

Contribution

This study identifies corrected minute ventilation as an independent predictor of mortality in mechanically ventilated COVID-19 ARDS patients.

Findings

Higher VEcorr was independently associated with increased in-hospital mortality.

Patients with higher VEcorr had elevated PaCO2, respiratory acidosis, and higher mean airway pressure.

Combining high VEcorr with hypercapnia significantly increased mortality risk.

Abstract

Background

Corrected minute ventilation (VEcorr) has been proposed as a surrogate marker for dead space ventilation and may be associated with increased mortality in COVID-19-related acute respiratory distress syndrome (ARDS). However, prior studies have shown inconsistent results, and the mechanisms contributing to elevated VEcorr remain unclear.

Methodology

A multicenter, observational study was conducted using data from the J-RECOVER registry, including 335 adult patients with COVID-19-related ARDS who received invasive mechanical ventilation. VEcorr was calculated using the initial ventilator settings and arterial blood gas values. Multivariable logistic regression analysis was performed to assess the association between VEcorr and in-hospital mortality, adjusting for potential confounders.

Results

Higher VEcorr was independently associated with increased in-hospital mortality (odds ratio = 1.11; 95% confidence interval = 1.01-1.23; p = 0.039). Patients with a higher VEcorr also had higher levels of fibrin degradation products and Fibrosis-4 scores. In addition, a higher VEcorr was significantly associated with elevated PaCO2 (≥45 mmHg), respiratory acidosis (pH <7.25), and increased mean airway pressure (≥15 cmH2O). Patients with both a high VEcorr and hypercapnia had significantly higher mortality.

Conclusions

VEcorr was independently associated with mortality in mechanically ventilated COVID-19 ARDS patients and might reflect underlying microvascular pathology. Monitoring VEcorr may help identify high-risk patients and inform ventilatory and therapeutic strategies.

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