Ventilatory variables and computed tomography features in COVID-19 ARDS and non-COVID-19-related ARDS: a prospective observational cohort study.

Summary

In a prospective ARDS cohort (n=222), non-COVID-19 pulmonary ARDS exhibited higher mechanical power, ventilatory ratio, peak inspiratory pressure, dynamic driving pressure, and CT severity across lobes versus COVID-19 ARDS during days 1–7. Mortality predictors differed: SOFA in COVID-19; BMI, immunocompromised status, SOFA, MP/PBW, and total CT score in non-COVID-19 ARDS.

Key Findings

• Non-COVID-19 pulmonary ARDS had higher mechanical power, ventilatory ratio, peak inspiratory pressure, and dynamic driving pressure with lower dynamic compliance from day 1 to 7.
• CT severity scores for each lobe and total were significantly higher in non-COVID-19 ARDS.
• Mortality predictors differed by group: SOFA in COVID-19; BMI, immunocompromised status, SOFA, MP/PBW, and total CT score in non-COVID-19 ARDS.

Clinical Implications

Ventilator settings may need tailoring by ARDS subtype: non-COVID-19 ARDS may require stricter control of driving pressure and mechanical power; CT severity can aid risk stratification. Monitor SOFA and mechanical indices accordingly.

Limitations

• Single-country cohort with temporal separation of pre-pandemic and pandemic enrollment periods
• Observational design limits causal inference and residual confounding cannot be excluded

Future Directions

Test phenotype-guided ventilation strategies in interventional trials and validate CT-mechanics-based risk models across centers.