• Elisa Estenssoro, Cecilia I Loudet, Arnaldo Dubin, Vanina S Kanoore Edul, Gustavo Plotnikow, Macarena Andrian, Ignacio Romero, Judith Sagardía, Marco Bezzi, Verónica Mandich, Carla Groer, Sebastián Torres, Cristina Orlandi, Paolo N Rubatto Birri, María F Valenti, Eleonora Cunto, María G Sáenz, Norberto Tiribelli, Vanina Aphalo, Lisandro Bettini, Fernando G Ríos, Rosa Reina, and SATI-COVID-19 Study Group.
• Hospital Interzonal de Agudos General San Martín, Buenos Aires, Argentina. Electronic address: estenssoro.elisa@gmail.com.
• J Crit Care. 2022 Oct 1; 71: 154021154021.

PurposeTo identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories.Materials And MethodsProspective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020-10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories.Results1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10-11 cmH2O). PaO2/FiO2, plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO2/FiO2 over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio.ConclusionHypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity-reflected by the PEEP level required.Copyright © 2022 Elsevier Inc. All rights reserved.

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