Ventilation management in COVID–19 ARDS vs ARDS from another origin

Introduction: It is uncertain whether ventilation management in patients with COVID-19 ARDS differs from that in patients with ARDS from another origin. Aim: To compare ventilation management in published cohorts of COVID-19 patients vs patients with ARDS from another origin. Methods: Two literature searches in PubMed were performed to identify observational studies reporting on ventilation management–one for COVID-19 ARDS, and one for ARDS from another origin. Results: The two searches identified 14 studies in COVID–19 ARDS patients, and 8 studies in patients with ARDS from another origin. In patients with COVID-19 ARDS, ventilation with a lower VT (median from 5.8 to 7.0 ml/kg PBW) was applied more rigorously than in patients with ARDS from another origin (median from 6.7 to 8.4 ml/kg PBW), albeit that Pplat was comparable between patients with COVID-19 ARDS (median from 24 to 27 cm H2O) and patients with ARDS from another origin (median from 19 to 26 cm H2O). PEEP and FiO2 were higher in patients with COVID-19 ARDS (median from 10 to 15 cm H2O, and from 60 to 80%) than in patients with ARDS from another origin (median from 7.5 to 10 cm H2O, and from 45 to 50%). Prone positioning was used more often in patients with COVID-19 ARDS (17 to 76%) than in patients with ARDS from another origin (1%, 6% and 16% in mild, moderate and severe ARDS). Conclusions: Remarkable differences exist in ventilation management of patients with COVID-19 ARDS vs patients with ARDS from another origin. Differences may, at least in part originate from disparities in oxygenation problems, that are more severe in COVID-19 ARDS patients.