Search

Your search keyword '"L.A. Hagens"' showing total 6 results
Start Over Author "L.A. Hagens"
6 results on '"L.A. Hagens"'

1. Prolonged indoleamine 2,3-dioxygenase-2 activity and associated cellular stress in post-acute sequelae of SARS-CoV-2 infectionResearch in context

Author

Lihui Guo, Brent Appelman, Kirsten Mooij-Kalverda, Riekelt H. Houtkooper, Michel van Weeghel, Frédéric M. Vaz, Annemiek Dijkhuis, Tamara Dekker, Barbara S. Smids, Jan Willem Duitman, Marianna Bugiani, Paul Brinkman, Jonne J. Sikkens, H.A. Ayesha Lavell, Rob C.I. Wüst, Michèle van Vugt, René Lutter, M.A. van Agtmael, A.G. Algera, B. Appelman, F.E.H.P. van Baarle, M. Beudel, H.J. Bogaard, M. Bomers, P.I. Bonta, L.D.J. Bos, M. Botta, J. de Brabander, G.J. de Bree, S. de Bruin, M. Bugiani, E.B. Bulle, O. Chouchane, A.P.M. Cloherty, D. Buis, M.C.F.J. de Rotte, M. Dijkstra, D.A. Dongelmans, R.W.G. Dujardin, P.E. Elbers, L.M. Fleuren, S.E. Geerlings, T.B.H. Geijtenbeek, A.R.J. Girbes, A. Goorhuis, M.P. Grobusch, L.A. Hagens, J. Hamann, V.C. Harris, R. Hemke, S.M. Hermans, L.M.A. Heunks, M.W. Hollmann, J. Horn, J.W. Hovius, M.D. de Jong, R. Koing, E.H.T. Lim, N. van Mourik, J.F. Nellen, E.J. Nossent, F. Paulus, E. Peters, D. Piña-Fuentes, T. van der Poll, B. Preckel, J.M. Prins, S.J. Raasveld, T.D.Y. Reijnders, M. Schinkel, F.A.P. Schrauwen, M.J. Schultz, A.R. Schuurman, J. Schuurmans, K. Sigaloff, M.A. Slim, P. Smeele, M.R. Smit, C. Stijnis, W. Stilma, C.E. Teunissen, P. Thoral, A.M. Tsonas, P.R. Tuinman, M. van der Valk, D.P. Veelo, C. Volleman, H. de Vries, L.A. van Vught, M. van Vugt, D. Wouters, A.H. Zwinderman, M.C. Brouwer, W.J. Wiersinga, A.P.J. Vlaar, and D. van de Beek

Subjects
IDO2, PASC, Autophagy, Apoptosis, Kynurenine, Mitochondrial_activity, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: Post-acute sequela of SARS-CoV-2 infection (PASC) encompass fatigue, post-exertional malaise and cognitive problems. The abundant expression of the tryptophan-catabolizing enzyme indoleamine 2,3-dioxygenase-2 (IDO2) in fatal/severe COVID-19, led us to determine, in an exploratory observational study, whether IDO2 is expressed and active in PASC, and may correlate with pathophysiology. Methods: Plasma or serum, and peripheral blood mononuclear cells (PBMC) were obtained from well-characterized PASC patients and SARS-CoV-2-infected individuals without PASC. We assessed tryptophan and its degradation products by UPLC-MS/MS. IDO2 activity, its potential consequences, and the involvement of the aryl hydrocarbon receptor (AHR) in IDO2 expression were determined in PBMC from another PASC cohort by immunohistochemistry (IHC) for IDO2, IDO1, AHR, kynurenine metabolites, autophagy, and apoptosis. These PBMC were also analyzed by metabolomics and for mitochondrial functioning by respirometry. IHC was also performed on autopsy brain material from two PASC patients. Findings: IDO2 is expressed and active in PBMC from PASC patients, as well as in brain tissue, long after SARS-CoV-2 infection. This is paralleled by autophagy, and in blood cells by reduced mitochondrial functioning, reduced intracellular levels of amino acids and Krebs cycle-related compounds. IDO2 expression and activity is triggered by SARS-CoV-2-infection, but the severity of SARS-CoV-2-induced pathology appears related to the generated specific kynurenine metabolites. Ex vivo, IDO2 expression and autophagy can be halted by an AHR antagonist. Interpretation: SARS-CoV-2 infection triggers long-lasting IDO2 expression, which can be halted by an AHR antagonist. The specific kynurenine catabolites may relate to SARS-CoV-2-induced symptoms and pathology. Funding: None.

Published
2023
Full Text
View/download PDF

2. Lung Microbiota of Critically Ill Patients with COVID-19 Are Associated with Nonresolving Acute Respiratory Distress Syndrome

Author

Robert F. J. Kullberg, Justin de Brabander, Leonoor S. Boers, Jason J. Biemond, Esther J. Nossent, Leo M. A. Heunks, Alexander P. J. Vlaar, Peter I. Bonta, Tom van der Poll, JanWillem Duitman, Lieuwe D. J. Bos, W. Joost Wiersinga, Anno Saris, Heder De Vries, Lilian J. Meijboom, Siebe G. Blok, Alex R. Schuurman, Tom D.Y. Reijnders, Juan J. Garcia Vallejo, Hetty Bontkes, René Lutter, Harm Jan Bogaard, S. de Bruin, R. Koning, M.A. van Agtmael, A.G. Algera, F.E.H.P. van Baarle, D.J.C. Bax, M. Beudel, M. Bomers, M. Botta, G.J. de Bree, M. Bugiani, E.B. Bulle, O. Chouchane, A.P.M. Cloherty, P.E. Elbers, L.M. Fleuren, S.E. Geerlings, B.F. Geerts, T.B.H. Geijtenbeek, A.R.J. Girbes, A. Goorhuis, M.P. Grobusch, F.M.J. Hafkamp, L.A. Hagens, J. Hamann, V.C. Harris, R. Hemke, S.M. Hermans, M.W. Hollmann, J. Horn, J.W. Hovius, M.D. de Jong, N. van Mourik, J.F Nellen, F. Paulus, E. Peters, B. Preckel, S.J. Raasveld, M. Schinkel, M.J. Schultz, K. Sigaloff, M.R. Smit, C. Stijnis, W. Stilma, C.E. Teunissen, P. Thoral, A.M. Tsonas, M. van der Valk, D.P. Veelo, M. van Vugt, D. Wouters, A.H. Zwinderman, M.C. Brouwer, D. van de Beek, Internal medicine, Pulmonary medicine, CCA - Cancer Treatment and quality of life, VU University medical center, ACS - Heart failure & arrhythmias, ACS - Pulmonary hypertension & thrombosis, Center of Experimental and Molecular Medicine, Graduate School, Intensive Care Medicine, ACS - Microcirculation, AII - Inflammatory diseases, Pulmonology, Infectious diseases, and 01 Internal and external specialisms

Subjects
Pulmonary and Respiratory Medicine, Respiratory Distress Syndrome, Tumor Necrosis Factor-alpha, Critical Illness, Microbiota, host–microbial interactions, COVID-19, Critical Care and Intensive Care Medicine, Respiration, Artificial, RNA, Ribosomal, 16S, Humans, artificial respiration, lung microbiome, Lung
Abstract

Rationale: Bacterial lung microbiota are correlated with lung inflammation and acute respiratory distress syndrome (ARDS) and altered in severe coronavirus disease (COVID-19). However, the association between lung microbiota (including fungi) and resolution of ARDS in COVID-19 remains unclear. We hypothesized that increased lung bacterial and fungal burdens are related to nonresolving ARDS and mortality in COVID-19. Objectives: To determine the relation between lung microbiota and clinical outcomes of COVID-19-related ARDS. Methods: This observational cohort study enrolled mechanically ventilated patients with COVID-19. All patients had ARDS and underwent bronchoscopy with BAL. Lung microbiota were profiled using 16S rRNA gene sequencing and quantitative PCR targeting the 16S and 18S rRNA genes. Key features of lung microbiota (bacterial and fungal burden, α-diversity, and community composition) served as predictors. Our primary outcome was successful extubation adjudicated 60 days after intubation, analyzed using a competing risk regression model with mortality as competing risk. Measurements and Main Results: BAL samples of 114 unique patients with COVID-19 were analyzed. Patients with increased lung bacterial and fungal burden were less likely to be extubated (subdistribution hazard ratio, 0.64 [95% confidence interval, 0.42-0.97]; P = 0.034 and 0.59 [95% confidence interval, 0.42-0.83]; P = 0.0027 per log10 increase in bacterial and fungal burden, respectively) and had higher mortality (bacterial burden, P = 0.012; fungal burden, P = 0.0498). Lung microbiota composition was associated with successful extubation (P = 0.0045). Proinflammatory cytokines (e.g., tumor necrosis factor-α) were associated with the microbial burdens. Conclusions: Bacterial and fungal lung microbiota are related to nonresolving ARDS in COVID-19 and represent an important contributor to heterogeneity in COVID-19-related ARDS.

Published
2022
Full Text
View/download PDF

3. Prognostication using SpO(2)/FiO(2) in invasively ventilated ICU patients with ARDS due to COVID-19-Insights from the PRoVENT-COVID study

Author

Jan-Paul Roozeman, Guido Mazzinari, Ary Serpa Neto, Markus W. Hollmann, Frederique Paulus, Marcus J. Schultz, Luigi Pisani, A.G. Algera, L.S. Boers, L.D.J. Bos, M. Botta, D.A. Dongelmans, M.W. Hollmann, J. Horn, F. Paulus, J. Pillay, M.J. Schultz, A. Serpa Neto, A.M. Tsonas, A.P.J. Vlaar, S. Ahuja, J.P. van Akkeren, C.K. Algoe, R.B. van Amstel, A. Artigas, O.L. Baur, P. van de Berg, A.E. van den Berg, D.C.J.J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, A.J.G.H. Bindels, M.M. de Boer, S. den Boer, M. Bogerd, J.S. Breel, H. de Bruin, S. de Bruin, C.L. Bruna, L.A. Buiteman-Kruizinga, O.L. Cremer, R.M. Determann, W. Dieperink, H.S. Franke, M.S. Galek-Aldridge, M.J. de Graaff, L.A. Hagens, J.J. Haringman, S.T. van der Heide, P.L.J. van der Heiden, N.F.L. Heijnen, S.J.P. Hiel, L.L. Hoeijmakers, L. Hol, M.E. Hoogendoorn, R. van der Horst, E.L.K. Ie, D. Ivanov, N.P. Juffermans, E. Kho, E.S. de Klerk, A.W.M.M. Koopman-van Gemert, M. Koopmans, S. Kucukcelebi, M.A. Kuiper, D.W. de Lange, N. van Mourik, S.G. Nijbroek, M. Onrust, E.A.N. Oostdijk, C.J. Pennartz, L. Pisani, I.M. Purmer, T.C.D. Rettig, J.P. Roozeman, M.T.U. Schuijt, M.E. Sleeswijk, M.R. Smit, P.E. Spronk, W. Stilma, A.C. Strang, P.R. Tuinman, C.M.A. Valk, F.L. Veen-Schra, L.I. Veldhuis, P. van Velzen, W.H. van der Ven, P. van Vliet, P.H.J. van der Voort, L. van Welie, H.J.F.T. Wesselink, H.H. van der Wier-Lubbers, B. van Wijk, T. Winters, W.Y. Wong, A.R.H. van Zanten, Intensive Care, MUMC+: MA Medische Staf IC (9), MUMC+: MA Arts Assistenten IC (9), RS: NUTRIM - R2 - Liver and digestive health, Lectoraat Critical Care, Faculteit Gezondheid, Anesthesiology, Graduate School, APH - Quality of Care, Intensive Care Medicine, ACS - Heart failure & arrhythmias, APH - Global Health, ACS - Microcirculation, Nursing, AII - Infectious diseases, AII - Inflammatory diseases, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, ANS - Neuroinfection & -inflammation, AII - Amsterdam institute for Infection and Immunity, Center of Experimental and Molecular Medicine, Emergency Department, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Pulmonary medicine, Intensive care medicine, and Group, PRoVENT-COVID Collaborative

Subjects
Resource limited settings, PAO2/FIO2, SpO/FiO, Acute respiratory distress syndrome, fungi, COVID-19, RESPIRATORY-DISTRESS-SYNDROME, respiratory system, Critical Care and Intensive Care Medicine, respiratory tract diseases, Pulse oximetry, Mechanical ventilation, RATIO, RACIAL BIAS, SpO(2)/FiO(2), circulatory and respiratory physiology
Abstract

Background: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID–19. Methods: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID–19. The primary endpoint was 28–day mortality. Results: In 869 invasively ventilated patients, 28–day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%–CI 0.46–0.96]) and on day 3 (OR, 0.70 [95%–CI 0.51–0.96]) were associated with 28–day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76–0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79). Conclusions: In this cohort of patients with ARDS due to COVID–19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28–day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID–19 patients.

Published
2022
Full Text
View/download PDF

4. Mortality associated with early changes in ARDS severity in COVID-19 patients

Author

Michiel T.U. Schuijt, Ignacio Martin-Loeches, Marcus J. Schultz, Frederique Paulus, Ary Serpa Neto, J.P. van Akkeren, A.G. Algera, C.K. Algoe, R.B. van Amstel, O.L. Baur, P. van de Berg, A.E. van den Berg, D.C.J.J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, A.J.G.H. Bindels, M.M. de Boer, S. den Boer, L.S. Boers, M. Bogerd, L.D.J. Bos, M. Botta, J.S. Breel, H. de Bruin, S. de Bruin, C.L. Bruna, L.A. Buiteman-Kruizinga, O. Cremer, R.M. Determann, W. Dieperink, D.A. Dongelmans, H.S. Franke, M.S. Galek Aldridge, M.J. de Graaff, L.A. Hagens, J.J. Haringman, N.F.L. Heijnen, S. Hiel, S.T. van der Heide, P.L.J. van der Heiden, L.L. Hoeijmakers, L. Hol, M.W. Hollmann, M.E. Hoogendoorn, J. Horn, R. van der Horst, E.L.K. Ie, D. Ivanov, N.P. Juffermans, E. Kho, E.S. de Klerk, A.W.M. Koopman, M. Koopmans, S. Kucukcelebi, M.A. Kuiper, D.W. de Lange, N. van Mourik, I. Martin-Loeches, S.G. Nijbroek, M. Onrust, E.A.N. Oostdijk, F. Paulus, C.J. Pennartz, J. Pillay, L. Pisani, I.M. Purmer, T.C.D. Rettig, J.P. Roozeman, M.T.U. Schuijt, M.J. Schultz, A. Serpa Neto, M.E. Sleeswijk, M.R. Smit, P.E. Spronk, W. Stilma, A.C. Strang, A.M. Tsonas, P.R. Tuinman, C.M.A. Valk, F.L. Veen, A.P.J. Vlaar, L.I. Veldhuis, P. van Velzen, W.H. van der Ven, P. van Vliet, P. van der Voort, H.H. van der Wier, L. van Welie, H.J.F.T. Wesselink, B. van Wijk, T. Winters, W.Y. Wong, A.R.H. van Zanten, Anesthesiology, Graduate School, Intensive Care Medicine, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, Nursing, Amsterdam institute for Infection and Immunity, ACS - Diabetes & metabolism, ACS - Microcirculation, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Lectoraat Critical Care, Faculteit Gezondheid, Urban Vitality, PRoVENT-COVID, Critical Care, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Arts Assistenten IC (9), Intensive Care, and MUMC+: MA Medische Staf IC (9)

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, ARDS, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), macromolecular substances, Critical Care and Intensive Care Medicine, Article, lung, Internal medicine, mensen, medicine, Clinical endpoint, COVID–19, In patient, Mortality, humans, longen, Coronavirus disease 2019, Acute respiratory distress syndrome, business.industry, SARS-CoV-2, COVID-19, ademhaling, medicine.disease, Respiration, Artificial, respiratory distress syndrome, Cohort, Artificial, Breathing, business, corona, respiration
Abstract

Purpose We investigated changes in ARDS severity and associations with outcome in COVID–19 ARDS patients. Methods We compared outcomes in patients with ARDS classified as ‘mild’, ‘moderate’ or ‘severe’ at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28–day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4. Results Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28–day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4. Conclusions In this cohort of COVID–19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches., Graphical abstract Unlabelled Image

Published
2021
Full Text
View/download PDF

6. Longitudinal respiratory subphenotypes in patients with COVID-19-related acute respiratory distress syndrome: results from three observational cohorts

Author

Lieuwe D J Bos, Michael Sjoding, Pratik Sinha, Sivasubramanium V Bhavani, Patrick G Lyons, Alice F Bewley, Michela Botta, Anissa M Tsonas, Ary Serpa Neto, Marcus J Schultz, Robert P Dickson, Frederique Paulus, J.P. van Akkeren, A.G. Algera, C.K. Algoe, R.B. van Amstel, A. Artigas, O.L. Baur, P. van de Berg, A.E. van den Berg, D.C.J.J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, A.J.G.H. Bindels, M.M. de Boer, S. den Boer, L.S. Boers, M. Bogerd, L.D.J. Bos, M. Botta, J.S. Breel, H. de Bruin, S. de Bruin, C.L. Bruna, L.A. Buiteman-Kruizinga, O. Cremer, R.M. Determann, W. Dieperink, D.A. Dongelmans, H.S. Franke, M.S. Galek-Aldridge, M.J. de Graaff, L.A. Hagens, J.J. Haringman, S.T. van der Heide, P.L.J. van der Heiden, N.F.L. Heijnen, S.J.P. Hiel, L.L. Hoeijmakers, L. Hol, M.W. Hollmann, M.E. Hoogendoorn, J. Horn, R. van der Horst, E.L.K. Ie, D. Ivanov, N.P. Juffermans, E. Kho, E.S. de Klerk, A.W.M.M. Koopman-van Gemert, M. Koopmans, S. Kucukcelebi, M.A. Kuiper, D.W. de Lange, I. Martin-Loeches, G. Mazzinari, D.M.P. van Meenen, L. Morales-Quinteros, N. van Mourik, S.G. Nijbroek, M. Onrust, E.A.N. Oostdijk, F. Paulus, C.J. Pennartz, J. Pillay, L. Pisani, I.M. Purmer, T.C.D. Rettig, J.P. Roozeman, M.T.U. Schuijt, M.J. Schultz, A. Serpa Neto, M.E. Sleeswijk, M.R. Smit, P.E. Spronk, W. Stilma, A.C. Strang, A.M. Tsonas, P.R. Tuinman, C.M.A. Valk, F.L. Veen-Schra, L.I. Veldhuis, P. van Velzen, W.H. van der Ven, A.P.J. Vlaar, P. van Vliet, P.H.J. van der Voort, L. van Welie, H.J.F.T. Wesselink, H.H. van der Wier-Lubbers, B. van Wijk, T. Winters, W.Y. Wong, A.R.H. van Zanten, Pulmonary medicine, Intensive care medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Arts Assistenten IC (9), Intensive Care, MUMC+: MA Medische Staf IC (9), Intensive Care Medicine, AII - Inflammatory diseases, Nursing, AII - Infectious diseases, Graduate School, AII - Amsterdam institute for Infection and Immunity, APH - Quality of Care, Anesthesiology, ANS - Neuroinfection & -inflammation, 06 Operations Centre and intensive care, ARD - Amsterdam Reproduction and Development, General Internal Medicine, ACS - Microcirculation, APH - Global Health, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Critical Care

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.medical_specialty, ARDS, business.industry, medicine.medical_treatment, COVID-19, Articles, acute respiratory distress syndrome, medicine.disease, Latent class model, critical care, respiratory subphenotypes, kritieke zorg, Internal medicine, Intensive care, Cohort, medicine, Breathing, business, Respiratory minute volume, Cohort study
Abstract

Background Patients with COVID-19-related acute respiratory distress syndrome (ARDS) have been postulated to present with distinct respiratory subphenotypes. However, most phenotyping schema have been limited by sample size, disregard for temporal dynamics, and insufficient validation. We aimed to identify respiratory subphenotypes of COVID-19-related ARDS using unbiased data-driven approaches.Methods PRoVENT-COVID was an investigator-initiated, national, multicentre, prospective, observational cohort study at 22 intensive care units (ICUs) in the Netherlands. Consecutive patients who had received invasive mechanical ventilation for COVID-19 (aged 18 years or older) served as the derivation cohort, and similar patients from two ICUs in the USA served as the replication cohorts. COVID-19 was confirmed by positive RT-PCR. We used latent class analysis to identify subphenotypes using clinically available respiratory data cross-sectionally at baseline, and longitudinally using 8-hourly data from the first 4 days of invasive ventilation. We used group-based trajectory modelling to evaluate trajectories of individual variables and to facilitate potential clinical translation. The PRoVENT-COVID study is registered with ClinicalTrials.gov, NCT04346342.Findings Between March 1, 2020, and May 15, 2020, 1007 patients were admitted to participating ICUs in the Netherlands, and included in the derivation cohort. Data for 288 patients were included in replication cohort 1 and 326 in replication cohort 2. Cross-sectional latent class analysis did not identify any underlying subphenotypes. Longitudinal latent dass analysis identified two distinct subphenotypes. Subphenotype 2 was characterised by higher mechanical power, minute ventilation, and ventilatory ratio over the first 4 days of invasive mechanical ventilation than subphenotype 1, but PaO2/FiO(2), pH, and compliance of the respiratory system did not differ between the two subphenotypes. 185 (28%) of 671 patients with subphenotype 1 and 109 (32%) of 336 patients with subphenotype 2 had died at day 28 (p=0.10). However, patients with subphenotype 2 had fewer ventilator-free days at day 28 (median 0, IQR 0-15 vs 5, 0-17; p=0.016) and more frequent venous thrombotic events (109[32%] of 336 patients vs 176 [26%] of 671 patients; p=0.048) compared with subphenotype 1. Group-based trajectory modelling revealed trajectories of ventilatory ratio and mechanical power with similar dynamics to those observed in latent class analysis-derived trajectory subphenotypes. The two trajectories were: a stable value for ventilatory ratio or mechanical power over the first 4 days of invasive mechanical ventilation (trajectory A) or an upward trajectory (trajectory B). However, upward trajectories were better independent prognosticators for 28-day mortality (OR 1.64, 95% CI 1.17-2.29 for ventilatory ratio; 1.82, 1.24-2.66 for mechanical power). The association between upward ventilatory ratio trajectories (trajectory B) and 28-day mortality was confirmed in the replication cohorts (OR 4.65, 95% CI 1. 87-11 6 for ventilatory ratio in replication cohort 1; 1-89, 1.05-3-37 for ventilatory ratio in replication cohort 2).Interpretation At baseline, COVID-19-related ARDS has no consistent respiratory subphenotype. Patients diverged from a fairly homogenous to a more heterogeneous population, with trajectories of ventilatory ratio and mechanical power being the most discriminatory. Modelling these parameters alone provided prognostic value for duration of mechanical ventilation and mortality. Copyright (C) 2021 Published by Elsevier Ltd. All rights reserved.

Published
2021
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results