Trajectories of hypoxemia and pulmonary mechanics of COVID-19 ARDS in the NorthCARDS dataset

  1. Daniel Jafari
  2. Amir Gandomi
  3. Alex Makhnevich
  4. Michael Qiu
  5. Daniel M. Rolston
  6. Eric P. Gottesman
  7. Adey Tsegaye
  8. Paul H. Mayo
  9. Molly E. Stewart
  10. Meng Zhang
  11. Negin Hajizadeh

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Abstract

Background

Understanding heterogeneity seen in patients with COVIDARDS and comparing to non-COVIDARDS may inform tailored treatments.

Methods

A multidisciplinary team of frontline clinicians and data scientists worked to create the Northwell COVIDARDS dataset (NorthCARDS) leveraging over 11,542 COVID-19 hospital admissions. The data was then summarized to examine descriptive differences based on clinically meaningful categories of lung compliance, and to examine trends in oxygenation.

Findings

Of the 1536 COVIDARDS patients in the NorthCARDS dataset, there were 531 (34.6%) who had very low lung compliance (< 20 ml/cmH 2 O), 970 (63.2%) with low-normal compliance (20–50 ml/cmH 2 O), and 35 (2.2%) with high lung compliance (> 50 ml/cmH 2 O). The very low compliance group had double the median time to intubation compared to the low-normal group (107.3 h (IQR 25.8, 239.2) vs. 39.5 h (IQR 5.4, 91.6)). Overall, 68.8% (n = 1057) of the patients died during hospitalization. In comparison to non-COVIDARDS reports, there were less patients in the high compliance category (2.2% vs. 12%, compliance ≥ 50 mL/cmH20), and more patients with P/F ≤ 150 (59.8% vs. 45.6%). There is a statistically significant correlation between compliance and P/F ratio. The Oxygenation Index is the highest in the very low compliance group (12.51, SD(6.15)), and lowest in high compliance group (8.78, SD(4.93)).

Conclusions

The respiratory system compliance distribution of COVIDARDS is similar to non-COVIDARDS. In some patients, there may be a relation between time to intubation and duration of high levels of supplemental oxygen treatment on trajectory of lung compliance.

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  1. Version published to 10.1186/s12890-021-01732-y
  2. Version published to 10.21203/rs.3.rs-770373/v1 on Research Square
  3. ScreenIT

    SciScore for 10.1101/2021.01.26.21250492: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was considered by Northwell Health Institutional Review Board as minimal-risk using data collected for routine clinical practice and waived the requirement for informed consent.
    Consent: This study was considered by Northwell Health Institutional Review Board as minimal-risk using data collected for routine clinical practice and waived the requirement for informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data was analyzed using Python 3·7 and several libraries including pandas, numpy, matplotlib, scipy, nltk, and re.
    Python
    suggested: (IPython, RRID:SCR_001658)
    matplotlib
    suggested: (MatPlotLib, RRID:SCR_008624)
    scipy
    suggested: (SciPy, RRID:SCR_008058)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Limitations of the present study are inherent to the retrospective nature of this data extraction from the electronic health record. We are unable to ensure that there was no significant airway resistance contributing to the measurement of dynamic compliance, and to account for the contribution of abdominal pressures and chest wall stiffness. The small and consistent margin of difference between static and dynamic compliance seen suggests that airway resistance contributed minimally to measured dynamic airway pressures. We assumed that the difference between dynamic and static compliance would be < 10 mL/ cm H2O due to airway resistance not being commonly observed in the early stages of COVIDARDS. In non-COVID-19 related ARDS the mean difference between peak and plateau pressures has been found to be 6-7 cmH2O.26 However, given that 50% (n=804) of patients had a BMI of over 30, it is possible that chest wall compliance contributed to a decreased measured compliance in some patients. A further limitation is our inability to control for factors which influenced decisions about timing of intubation for COVID19 patients. For example, those who were intubated earlier may have had altered mental status which could confound differences seen in mortality associated with lung compliance. Limits to resuscitation due to patient and family preference have also not been presented in this descriptive analysis. These factors will need to be accounted for in future inferential studies In sum...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  4. Version published to 10.1101/2021.01.26.21250492v1 on medRxiv