• Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D Gumucio-Sanguino, Maria Del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, M AlbaicetaGuillermoGCentro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spai, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII).
• Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain. atorres@clinic.cat.
• Crit Care. 2021 Sep 13; 25 (1): 331.

BackgroundMortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission.MethodsMulticenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.ResultsOf the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47).ConclusionsHigher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.© 2021. The Author(s).

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