• Benoit Vandenbunder, Stephan Ehrmann, Michael Piagnerelli, Bertrand Sauneuf, Nicolas Serck, Thibaud Soumagne, Julien Textoris, Christophe Vinsonneau, Nadia Aissaoui, Gauthier Blonz, Giuseppe Carbutti, Romain Courcelle, Alain D'hondt, Stephane Gaudry, Julien Higny, Geoffroy Horlait, Sami Hraiech, Laurent Lefebvre, Francois Lejeune, Andre Ly, LascarrouJean-BaptisteJBMédecine Intensive Réanimation, CHU Nantes, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 9, France., David Grimaldi, and COVADIS study group.
• Groupe des anesthésistes réanimateurs, Hôpital Privé d'Antony, Antony, France.
• Crit Care. 2021 Feb 8; 25 (1): 5252.

BackgroundControversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14.MethodsIn this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation.ResultsThe mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98-1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13-3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88-0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome.ConclusionIn a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.

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