P0.1 is Associated with Duration of Ventilation and Mortality in Patients with COVID-19 ARDS

Rationale In acute respiratory distress syndrome (ARDS), optimal timing of transition from controlled to assisted ventilation and the ventilatory parameters which define this are unknown. Premature transition may impair recovery of an injured lung through patient self-inflicted lung injury. Objectives To investigate whether the airway occlusion pressure (P0.1) directly after transition to assisted ventilation is associated with the duration of ventilation and mortality. Methods Invasively ventilated patients with COVID-19 ARDS were retrospectively identified. P0.1 was recorded for 24 hours after transition to assisted ventilation. The primary endpoint was the number of ventilator-free days while being alive in the 28 days following the first transition from controlled to assisted ventilation (VFDav-28). Secondary outcome was ICU mortality. Multivariable logistic regression was used to identify variables independently associated with outcome parameters. ROC curves were generated to assess predictive values. Measurements and Main Results 78 patients with COVID-ARDS were included. Higher (more negative) P0.1 was associated with less VFDav-28 and higher ICU mortality. The predictive value of P0.1 for both VFDav-28 and mortality was good (AUC 0.75). Conclusions This study shows that P0.1 directy after transition to assited ventilation is associated with prolonged duration of invasive ventilation and ICU mortality.