Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS. This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation. The median age of the 87 participants was 71.0 (62.0–78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p < 0.001, day 1). COVID-19 and influenza A initially showed different directions for peak inspiratory pressure and dynamic compliance; however, after day 3, both groups exhibited similar directions. Dynamic driving pressure exhibited opposite trends between the two groups during mechanical ventilation. Respiratory mechanics show clear differences between COVID-19-induced ARDS and influenza A induced ARDS. Based on these findings, we can consider future treatment strategies for COVID-19-induced ARDS.

中文翻译：

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COVID-19与甲型流感患者急性呼吸窘迫综合征机械通气呼吸力学差异

与其他病毒引起的急性呼吸窘迫综合征 (ARDS) 相比，在机械通气治疗方面是否应以不同的方式处理 COVID-19 引起的急性呼吸窘迫综合征 (ARDS) 尚存在争议。因此，我们的目的是确定 COVID-19 诱发的 ARDS 的呼吸机械特征是否与甲型流感诱发的 ARDS 不同，以便为 COVID-19 诱发的 ARDS 的机械通气治疗奠定基础。这是一项回顾性队列研究，比较了 COVID-19 诱发的 ARDS 和甲型流感诱发的 ARDS 患者。我们纳入了 2015 年 1 月至 2021 年 7 月期间根据柏林定义诊断为 ARDS 的年龄≥ 19 岁的重症监护病房 (ICU) 患者，这些患者患有 COVID-19 或甲型流感。在第一天的特定时间收集了呼吸力学的通气参数。插管后，三，七。87 名参与者的中位年龄为 71.0（62.0-78.0）岁，其中 63.2% 为男性。在机械通气初始阶段，COVID-19 诱发的 ARDS 的动脉血氧分压与吸入氧浓度分数的比值低于甲型流感诱发的 ARDS（甲型流感诱发的 ARDS 216.1 与 COVID-19 诱发的 ARDS） 19 诱导的 ARDS 167.9，p = 0.009，第 1 天）。在整个随访期间，COVID-19 组的呼气末正压始终较高（7.0 与 10.0，p < 0.001，第 1 天）。COVID-19 和甲型流感最初在吸气峰值压力和动态顺应性方面表现出不同的方向；然而，第三天之后，两组都表现出相似的方向。在机械通气期间，两组之间的动态驱动压表现出相反的趋势。呼吸力学显示出 COVID-19 诱发的 ARDS 和甲型流感诱发的 ARDS 之间存在明显差异。根据这些发现，我们可以考虑未来针对 COVID-19 诱发的 ARDS 的治疗策略。