A Comparative Analysis of Ventilator Mechanics and Outcomes in COVID-19 vs. Non-COVID ARDS Patients in the Emergency Department: A Cohort Study

Background & Aim: Mechanical ventilatory support is frequently required in patients with acute respiratory distress syndrome (ARDS). However, early differences in ventilatory mechanics and severity scoring between COVID-19 and Non-COVID ARDS remain uncertain. This study aimed to compare respiratory parameters and clinical scores in COVID-19 and Non-COVID ARDS patients managed in the emergency department (ED) and to evaluate their association with in-hospital mortality. Methods: This prospective cohort study included adult patients diagnosed with ARDS (PaO₂/FiO₂ < 300 mmHg) who received mechanical ventilatory support in the ED. Initial respiratory parameters and clinical severity scores (SOFA, APACHE II, PSI) were recorded within the first 30 minutes. Patients were categorized into COVID-19 and Non-COVID groups, and outcomes were compared between survivors and non-survivors. Results: A total of 70 patients were included: 32 (45.7%) in the COVID-19 group and 38 (54.3%) in the Non-COVID group. Plateau pressure was significantly higher in the COVID-19 group (30.0 vs. 21.0 cmH₂O, p = 0.01), while static compliance was lower without statistical significance. No ventilatory parameter predicted mortality. Among clinical scores, SOFA was significantly higher in both COVID-19 patients and non-survivors. Additionally, APACHE II score was significantly higher in non-survivors within the COVID-19 group, suggesting its potential prognostic value. PSI did not show a significant difference. Conclusion: While COVID-19 patients had higher plateau pressures than Non-COVID patients, early respiratory mechanics were not associated with mortality. SOFA scores differed between groups without a significant association with outcome. Notably, APACHE II was the only scoring system that significantly predicted mortality within the COVID-19 group, suggesting its potential usefulness in early risk assessment.