• Michael W Sjoding, Andrew J Admon, Anjan K Saha, Stephen G Kay, Christopher A Brown, Ivan Co, Dru Claar, Jakob I McSparron, and Robert P Dickson.
• University of Michigan, Internal Medicine Pulmonary Critical Care, Ann Arbor, Michigan, United States.
• Ann Am Thorac Soc. 2021 Feb 12.

RationalePatients with severe coronavirus disease 2019 (COVID-19) meet clinical criteria for the acute respiratory distress syndrome (ARDS), yet early reports suggested they differ physiologically and clinically from patients with non-COVID-19 ARDS, prompting treatment recommendations that deviate from standard evidence-based practices for ARDS.ObjectivesTo compare respiratory physiology, clinical outcomes, and extrapulmonary clinical features of severe COVID-19 with non-COVID ARDS.MethodsWe performed a retrospective cohort study, comparing 130 consecutive mechanically ventilated patients with severe COVID-19 with 382 consecutive mechanically ventilated patients with non-COVID-19 ARDS. Initial respiratory physiology and 28-day outcomes were compared. Extrapulmonary manifestations (inflammation, extrapulmonary organ injury, and coagulation) were compared in an exploratory analysis.ResultsComparison of patients with COVID-19 and non-COVID-19 ARDS suggested small differences in respiratory compliance, ventilatory efficiency, and oxygenation. 28-day mortality was 30% in COVID-19 patients and 38% in non-COVID ARDS. In adjusted analysis, point estimates of differences in time-to-breathing-unassisted at 28 days (adjusted SHR 0.98 [95% CI 0.77-1.26]) and 28-day mortality (risk ratio = 1.01 [95% CI 0.72-1.42]) were small for COVID-19 vs. non-COVID ARDS, although the confidence intervals for these estimates include moderate differences. Patients with COVID-19 had lower neutrophil counts but did not differ in lymphocyte count or other measures of systemic inflammation.ConclusionsIn this single center cohort, we found no evidence for large differences between COVID-19 and non-COVID ARDS. Many key clinical features of severe COVID-19 were similar to those of non-COVID-19 ARDS, including respiratory physiology and clinical outcomes, although our sample size precludes definitive conclusions. Further studies are needed to define COVID-19-specific pathophysiology before deviation from evidence-based treatment practices can be recommended.

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