Category Archives: Original Research

Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study

Andrés Mauricio Enríquez Popayán1, Iván Ignacio Ramírez2, Juan Felipe Zúñiga3, Ruvistay Gutierrez-Arias4, Mayda Alejandra Jiménez Pérez5, Henry Mauricio Parada-Gereda6, Luis Fernando Pardo Cocuy7, Ana Lucia Rangel Colmenares8, Nubia Castro Chaparro9, Ana Pinza Ortega10, Jorge Martínez Díaz11, Johanna Hurtado Laverde12, Joismer Alejandro Henao Cruz13

1 Departamento de Fisioterapia en Cuidado Intensivo, GyO Medical, Yopal, Colombia; Departamento de Fisioterapia en Cuidado Intensivo, Clínica SIMALINK, Yopal, Colombia
2 Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Diego Portales, Santiago, Chile
3 Departamento de Fisioterapia en Cuidado Intensivo, Clínica de Occidente, Cali, Colombia
4 Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
5 Departamento de Fisioterapia en Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia
6 Unidad de Cuidado Intensivo, Clínica Reina Sofia, Bogotá, Colombia; Clínica Colsanitas, Grupo de Investigación en Nutrición Clínica y Rehabilitación-Keralty, Bogotá, Colombia. ???Especialización de Fisioterapia en Paciente Adulto Critico, Universidad del Rosario, Bogotá, Colombia.
7 Departamento de Fisioterapia en Cuidado Intensivo, Hospital Universitario Mayor Méderi, Bogotá, Colombia; Especialización de Fisioterapia en Paciente Adulto Critico, Universidad del Rosario, Bogotá, Colombia.
8 Departamento de Fisioterapia en Cuidado Intensivo, Clínica Norte, Cúcuta, Colombia; Departamento de Fisioterapia en Cuidado Intensivo, Clínica San José, Cúcuta, Colombia
9 Departamento de Cuidado Intensivo, Lumira SAS, Cali, Colombia
10 Departamento de Fisioterapia en Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia; Programa de Fisioterapia, Universidad Mariana, Pasto, Colombia; Grupo de Investigación en Medicina Critica GMC, Fundación Hospital San Pedro, Pasto, Colombia
11 Departamento de Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia; Programa de Medicina, Fundación Universidad San Martin, Pasto, Colombia; Grupo de Investigación en Medicina Critica GMC, Fundación Hospital San Pedro, Pasto, Colombia
12 Programa de Terapia Respiratoria, Universidad Manuela Beltrán, Bogotá, Colombia
13 Departamento de Fisioterapia en Cuidado Intensivo, Hospital Universitario de Caldas, Manizales, Colombia

DOI: 10.2478/jccm-2025-0017

Introduction: Patient-ventilator asynchrony (PVA) is frequent in intensive care. Its presence is associated with prolonged days of mechanical ventilation and may lead to increased mortality in the intensive care unit (ICU) and hospital. Little is known about the ability of Colombian intensive care professionals to identify asynchronies, and the factors associated with their correct identification are not apparent.
Aim of the study: To describe the ability of Colombian intensive care professionals to identify patient-ventilator asynchronies (PVA) using waveform analysis. In addition, to define the characteristics associated with correctly detecting PVA.
Material and methods: We conducted a multicenter, cross-sectional, national survey-based study between January and August 2024. Colombian physiotherapists, respiratory therapists, nurses and intensive care physicians from 24 departments participated in the study. An online survey was used. They were asked to identify six different PVAs presented as videos. The videos were displayed using pressure/time and flow/time waveform of a Puritan Bennett 840 ventilator.
Results: We recruited 900 participants, 60% female, most of whom were physiotherapists (53%). Most professionals had specialty training in critical care (42%), and 32% reported having specific PVA training. Double triggering was the most frequently identified PVA (75%). However, only 3.67% of participants recognized all six PVAs. According to multiple logistic regression analysis, working in a mixed unit (OR 2.59; 95% CI 1.19 – 5.54), caring for neonates (OR 5.19; 95% CI 1.77 – 15.20), and having specific training (OR 2.38; 95% CI 1.16 – 4.76) increases the chance of correctly recognizing all PVAs.
Conclusion: In Colombia, a low percentage of professionals recognize all PVAs. Having specific training in this topic, working in mixed ICUs and neonatal intensive care was significantly associated with identifying all PVAs.

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Latent class analysis for identification of sub-phenotypes predicting prognosis in hospitalized out-of-hospital cardiac arrest

Yuki Kishihara1, Hideto Yasuda1–4, Masahiro Kashiura1, Shunsuke Amagasa5, Hiroyuki Tamura1, Yutaro Shinzato1, Takashi Moriya1

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
3 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
4 School of Nursing and Midwifery; Alliance for Vascular Access Teaching and Research, Griffith University, Australia
5 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan

DOI: 10.2478/jccm-2025-0016

Aim of the study: To determine which out-of-hospital cardiac arrest (OHCA) patients should receive advanced treatment is extremely challenging. The objective was to identify sub-phenotypes predicting the prognoses of adult OHCA patients by latent class analysis (LCA) using data up to just after admission.
Material and Methods: We conducted a retrospective observational study using multicentre OHCA registry from 95 Japanese hospitals including adult non-traumatic hospitalized OHCA. The primary outcome was 30-day favourable neurological outcome. Our LCA used clinically relevant variables up to just after admission and the optimal class number was determined from clinical importance and Bayesian information criterion. The associations between sub-phenotypes and outcomes were analysed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Our LCA included 2,162 patients and identified four sub-phenotypes. The base excess on hospital arrival had the highest discriminative power. Thirty-day favourable neurological outcomes were observed in 526 patients (24.3%), including 284 (53.8%) in Group 1, 179 (21.2%) in Group 2, 26 (11.4%) in Group 3, and 37 (6.6%) in Group 4. Prehospital return of spontaneous circulation (ROSC) was achieved in 1,009 patients (46.7%), including 379 (81.8%) in Group 1, 340 (40.3%) in Group 2, 115 (50.4%) in Group 3, and 175 (31.1%) in Group 4. Univariate logistic regression analysis for primary outcome using Group 4 as reference revealed ORs (95% CI) of 16.5 (11.4–24.1) in Group 1, 3.83 (2.64–5.56) in Group 2, and 1.83 (1.08–3.10) in Group 3.
Conclusions: Our LCA classified OHCA into four sub-phenotypes showing significant differences for prognosis. In cases who achieved prehospital ROSC, it might be meaningful to continue advanced therapeutic interventions.

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Use of prone position in spontaneous breathing in patients with COVID-19

Rodrigo Cerqueira Borges1, Isadora Salvador Rocco2, Camila Botana Alves Ferreira1, Mauricio Kenzo Tobara1, Cristiane Helena Papacidero1, Vanessa Chaves Barreto Ferreira1, Andrey Wirgues Sousa1

1 Hospital Samaritano Higienópolis, São Paulo, Brazil
2 Universidade Federal de Sao Paulo, Brazil

DOI: 10.2478/jccm-2025-0015

Objective: To investigate if awake prone position (PP) reduces the rate of endotracheal intubation and mortality in patients with COVID-19 admitted to the intensive care unit (ICU).
Methods: This was a retrospective cohort study of 726 patients who were admitted to the ICU with acute hypoxic respiratory failure secondary to COVID-19. The protocol of the institution recommended the use of awake PP in patients with nasal catheter with an oxygen flow ≥ 5 L/min and SpO2 ≤ 90% or a high-flow nasal catheter (HFNC) with FiO2 ≥ 50% and SpO2 ≤ 90%. The following data were collected: age, comorbidities, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, duration of invasive and noninvasive MV, HFNC therapy, nitric oxide therapy, hemodialysis and PP while spontaneously breathing.
Results: There was a higher mortality rate in the supine position group (27.1%) than in the awake PP group (13.9%). There was no significant difference in the time on MV or number of patients on MV (p>0.05). The variables with p < 0.05 in the bivariate analysis were entered into the Cox regression model. The model was adjusted for awake PP, sex, age, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, chronic arterial disease, and noninvasive ventilation. The only variable associated with lower mortality over time was awake PP (hazard ratio: 0.55; 95% confidence interval: 0.33-0.92).
Conclusion: Awake prone position has been shown to be a safe and effective therapy that reduced mortality but not the risk of intubation in patients with COVID-19.

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The effect of antiseizure medication on mortality in spontaneous aneurysmal subarachnoid hemorrhage

John Harold Kanter, Adam C. Glaser, Pablo Martinez-Camblor, Jakob V.E. Gerstl, Anna B. Lebouille-Veldman, Harshit Arora, Lauren Buhl, Myles D. Boone, Christopher S. Ogilvy

1 Department of Neurological Surgery, University of California, San Francisco, California; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
2 Department of Neurological Surgery, Brigham and Women’s Hospital, Harvard Medical School Department of Neurological Surgery, Boston Children’s Hospital, USA
3 Department of Anesthesiology, Dartmouth Health Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, USA
4 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA
5 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
6 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA. Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
7 Department of Anesthesiology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
8 Department of Anesthesiology, Dartmouth Health Department of Neurology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
9 Neurosurgical Service, BIDMC Brain Aneurysm Institute, Harvard Medical School, Beth Israel Deaconess Medical Center, USA

DOI: 10.2478/jccm-2025-0014

Background: Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality in the United States. The efficacy of early antiseizure medication (ASM) is debated. Recent literature reports seizure rates ranging from 7.8% to 15.2% following spontaneous aSAH. Current guidelines recommend use of early ASM in patients with “high-risk features,” but whether early ASM use decreases the rate of death associated with aSAH remains unclear. This study assessed whether early administration of early ASM impacts mortality rates after spontaneous aSAH.
Methods: We conducted a retrospective cohort study using a publicly available dataset from the Massachusetts Institute of Technology, Medical Information Mart for Intensive Care-III (MIMIC) database of all patients over the age of 18 with spontaneous aSAH resulting in an intensive care unit (ICU) admission to a major United States trauma center from 2001 to 2012. The primary exposure was receiving early ASM and primary outcome of death within 7 days. Different regression models were created to explore the association between early ASM administration within 24 hours of admission and a composite outcome of seizure and/or death within 7 days of admission. Secondary outcomes included 30-day and one-year mortality.
Results: Of 253 patients with spontaneous aSAH, 148 received early ASM within 24 hours. Patients who did receive early ASM were less likely to die within 7 days of admission (adjusted odd ratio, [aOR]: 0.26 95% CI 0.10 to 0.68; P=0.006) but were more likely to have a seizure (aOR: 7.63 95% CI 2.07 to 28.17; P=0.002).
Conclusion: Early ASM administration was associated with lower rates of death and composite death/seizure within 7 days of admission among patients who presented to an ICU with spontaneous aSAH. These findings suggest broader use of early ASM in patients who present with spontaneous aSAH may improve early mortality.

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Poor clinical outcomes among hospitalized obese patients with COVID-19 are related to inflammation and not respiratory mechanics

Jordan N Edwards, Tomas Ganz, Elizabeta Nemeth, Emily J Martin, Nicholas J Jackson, Airie Kim

David Geffen School of Medicine, University of California Los Angeles, CA, USA

DOI: 10.2478/jccm-2025-0012

Introduction: The coronavirus disease 2019 (COVID-19) has infected millions of people worldwide resulting in high morbidity and mortality. Obesity is known to cause metabolic derangements and precipitate worse outcomes from viral pneumonia, potentially secondary to increased inflammation and/or altered respiratory mechanics.
Aim of the Study: Our study’s aim was to examine the relationships among BMI, systemic inflammation, and respiratory mechanics in determining clinical outcomes.
Materials and Methods: This retrospective, observational cohort study included 199 adult patients with confirmed COVID-19 who were hospitalized at a quaternary-referral academic health system. Data were manually extracted from electronic medical records, including baseline demographics and clinical profiles, inflammatory markers, measures of respiratory mechanics, and clinical outcomes. We used the rank-sum test to compare the distributions of BMI and inflammatory markers between those with and without specific clinical outcomes, and the Pearson correlation to measure the correlations between BMI and inflammatory markers or respiratory mechanics.
Results: Higher BMI was associated with worse clinical outcomes, including the need for Intensive Care Unit (ICU) admission, invasive mechanical ventilation (IMV), neuromuscular blockade, and prone positioning, particularly in male patients. Inflammation, as measured by C-reactive protein, lactate dehydrogenase (LDH), ferritin, and D-Dimer, was also increased in both male and female patients who required ICU admission, IMV, neuromuscular blockade, and prone positioning. However, only male patients had a positive correlation of LDH and D-Dimer levels with BMI. There was no correlation between BMI and respiratory mechanics, as measured by static compliance and the response to prone positioning.
Conclusions: Our findings suggest that the metabolic dysfunction and systemic inflammation seen in obesity, and not dysfunctional respiratory physiology, drive the negative clinical outcomes seen in this cohort of hospitalized COVID-19 patients.

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Machine learning to predict extubation success using the spontaneous breathing trial, objective cough measurement, and diaphragmatic contraction velocity: Secondary analysis of the COBRE-US trial

Fabio Varón-Vega1,2, Eduardo Tuta-Quintero1,2,3, Adriana Maldonado-Franco3, Henry Robayo-Amórtegui3, Luis F Giraldo-Cadavid1,3, Daniel Botero-Rosas3

1 Fundación Neumológica Colombiana, Bogotá, Colombia
2 Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
3 Universidad de La Sabana, Chía, Colombia

DOI: 10.2478/jccm-2025-0009

Introduction: Determining the optimal timing for extubation in critically ill patients is essential to prevent complications. Predictive models based on Machine Learning (ML) have proven effective in anticipating weaning success, thereby improving clinical outcomes.
Aim of the study: The study aimed to evaluate the predictive capacity of five ML techniques, both supervised and unsupervised, applied to the spontaneous breathing trial (SBT), objective cough measurement (OCM), and diaphragmatic contraction velocity (DCV) to estimate a favorable outcome of SBT and extubation in critically ill patients.
Material and Methods: A post hoc analysis conducted on the COBRE-US study. The study included ICU patients who underwent evaluation of SBT, OCM, and DCV. Five ML techniques were applied: unsupervised and supervised to the data in both a training group and a test group. The diagnostic performance of each method was determined using accuracy.
Results: In predicting SBT success, all supervised methods displayed the same accuracy in the training group (77.3%) and in the test group (69.6%). In predicting extubation success, decision trees demonstrated the highest diagnostic accuracy, 89.8% for the training group and 95.7% for the test group. The other supervised methods also showed a good diagnostic accuracy: 85.9% for the training group and 93.5% for the test group.
Conclusions: In predictive models using OCM, DCV, and SBT as input variables through five ML techniques, decision trees and artificial neural networks demonstrated the best diagnostic performance. This suggests that these models can effectively classify patients who are likely to succeed in SBT and extubation during the weaning process from mechanical ventilation.

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Risk factors and outcomes of critically ill pregnant COVID-19 patients: Experience from the first and second waves of the pandemic

Dita Aditianingsih1,2, Noor Hafidz1,2, Aino Nindya Auerkari1,2, Zarah Tin Cahyaningrum1,
El Nissi Leonard1, Chrisella Annabelle1

1 Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
2 Department of Anesthesiology and Intensive Care, Universitas Indonesia Hospital, Indonesia

DOI: 10.2478/jccm-2025-0008

Introduction: Understanding the association between risk factors and clinical outcomes of COVID-19 can lead to identifying suitable management strategies for reducing the mortality rate among maternal COVID-19 patients in the ICU.
Aim of the Study: This study aims to investigate the clinical outcomes and risk factors associated with pregnant and postpartum women diagnosed with COVID-19 and admitted to the intensive care unit (ICU) between May 2020 and September 2021.
Materials and Methods: This retrospective cohort study was conducted at the Universitas Indonesia Hospital. Secondary data was collected from the medical records to include all pregnant and postpartum women diagnosed with confirmed COVID-19 admitted to the hospital during the research period.
Results: The study included 113 patients and found that admission to the ICU, age, and gestational age significantly influenced clinical outcomes, with a mortality rate of 42.11% among ICU-admitted patients. Pre-existing comorbidities such as type-2 diabetes mellitus, congestive heart failure, and coronary artery disease were associated with ICU admission. Having at least one comorbidity was found to increase the mortality rate by six-fold.
Conclusions: The study emphasizes the importance of monitoring and evaluating maternal and fetal complications during COVID-19 infection, highlighting the need for multidisciplinary management involving intensivists, obstetricians, anesthesiologists, and infectious disease specialists. The findings underscore the significance of baseline health status in treatment planning and the potential for evidence-based interventions to improve maternal outcomes and pregnancy preservation. Further research is warranted to validate these results and enhance understanding of the underlying pathophysiology.

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Association between hospital case volume and mortality in pediatric sepsis: A retrospective observational study using a Japanese nationwide inpatient database

Shingo Ohki1,2, Makoto Otani3, Shinichi Tomioka1,4, Kosaku Komiya5, Hideki Kawamura6, Taka-aki Nakada7, Satoshi Nakagawa8, Shinya Matsuda3, Nobuaki Shime1

1 Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
2 Shonan Kamakura General Hospital, Kamakura, Japan
3 University of Occupational and Environmental Health, Kitakyushu, Japan
4 Kotonoha Collaboration Clinic, Kitakyushu, Japan
5 Faculty of Medicine, Oita University, Oita, Japan
6 Kagoshima University Hospital, Kagoshima, Japan
7 Graduate School of Medicine, Chiba University, Chiba, Japan
8 National Center for Child Health and Development, Tokyo, Japan

DOI: 10.2478/jccm-2025-0006

Introduction: The survival benefits of treatment at high-volume hospitals (HVHs) are well-documented for several critical pediatric conditions. However, their impact on pediatric sepsis, a leading cause of mortality among children, remains understudied.
Aim of the study: To investigate the association between hospital case volume and mortality rates in pediatric sepsis.
Material and Methods: We conducted a retrospective cohort study using data from the Diagnosis Procedure Combination database. The study included patients who met the following criteria: 1) aged 28 days to 17 years; 2) discharged from the hospital between April 2014 and March 2018; 3) had a sepsis diagnosis coded under the International Classification of Diseases, 10th revision; 4) underwent blood cultures on hospital admission day (day 0) or day 1; 5) received antimicrobial agents on day 0 or 1; and 6) required at least one organ support measure (e.g., mechanical ventilation or vasopressors) on day 0 or 1. Hospitals were categorized by case volume during the study period, with HVHs defined as those in the highest quartile and low-volume hospitals (LVHs) as those in the remaining quartiles. In-hospital mortality rates between HVH and LVH groups were compared using mixed-effects logistic regression analysis with propensity score (PS) matching.
Results: A total of 934 pediatric patients were included in the study, with an overall in-hospital mortality rate of 16.1%. Of them, 234 were treated at 5 HVHs (≥26 patients in 4 years), and 700 at 234 LVHs (<26 patients in 4 years). Upon PS matching, patients treated at HVHs demonstrated significantly lower odds of in-hospital mortality compared with those treated at LVHs (odds ratio, 0.42; 95% confidence interval, 0.22–0.80; P = 0.008).
Conclusions: In pediatric patients with sepsis, treatment at HVHs was associated with lower odds of in-hospital mortality.

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What proteins and albumins in bronchoalveolar lavage fluid and serum could tell us in COVID-19 and influenza acute respiratory distress syndrome on mechanical ventilation patient – A prospective double center study

Anita Djurdjevic Svraka1, Dragan Svraka1,2, Bosa Mrjanic Azaric1, Jovana Malic1,2, Goran Baric1,2, Pedja Kovacevic1,2

1 Faculty of Medicine, University of Banja Luka, Banjaluka, Bosnia and Herzegovina
2 University Clinical Centre of the Republic of Srpska

DOI: 10.2478/jccm-2025-0005

Introduction: The extent of in vivo damage to the alveolar-capillary membrane in patients with primary lung injury remains unclear. In cases of ARDS related to COVID-19 and Influenza type A, the complexity of the damage increases further, as viral pneumonia cannot currently be treated with a causal approach.
Aims of the study: Our primary goal is to enhance the understanding of Acute Respiratory Distress Syndrome (ARDS) by demonstrating damage to the alveocapillary membrane in critically ill patients with COVID-19 and influenza type A. We will achieve this by measuring the levels of proteins and albumin in bronchoalveolar fluid (BAL) and serum. Our secondary objective is to assess patient outcomes related to elevated protein and albumin levels in both BAL and blood serum, which will deepen our understanding of this complex condition.
Materials and methods: Bronchoalveolar lavage (BAL) fluid and serum samples were meticulously collected from a total of 64 patients, categorized into three distinct groups: 30 patients diagnosed with COVID-19-related acute respiratory distress syndrome (ARDS), 14 patients with influenza type A (H1N1 strain), also experiencing ARDS, and a control group consisting of 20 patients who were preoperatively prepared for elective surgical procedures without any diagnosed lung disease. The careful selection and categorization of patients ensure the robustness of our study. BAL samples were taken within the first 24 hours following the commencement of invasive mechanical ventilation in the intensive care unit, alongside measurements of serum albumin levels. In the control group, BAL and serum samples were collected after the induction of general endotracheal anaesthesia.
Results: Patients in the COVID-19 group are significantly older than those in the Influenza type A (H1N1) group, with median ages of 72.5 years and 62 years, respectively (p < 0.01, Mann-Whitney U test). Furthermore, serum albumin levels (measured in g/L) revealed significant differences across all three groups in the overall sample, yielding a p-value of less than 0.01 according to ANOVA. In terms of treatment outcomes, serum albumin levels also exhibited a significant correlation, with a p-value of 0.03 (Mann-Whitney U test). A reduction in serum albumin levels (below 35 g/L), combined with elevated protein levels in bronchoalveolar lavage (BAL), serves as a predictor of poor outcomes in patients with acute respiratory distress syndrome (ARDS), as indicated by a p-value of less than 0.01 (ANOVA).
Conclusions: Our findings indicate that protein and albumin levels in bronchoalveolar lavage (BAL) fluid are elevated in severe acute respiratory distress syndrome (ARDS) cases. This suggests that BAL can effectively evaluate protein levels and fractions, which could significantly assist in assessing damage to the alveolocapillary membrane. Additionally, the increased albumin levels in BAL, often accompanied by a decrease in serum albumin levels, may serve as a valuable indicator of compromised integrity of the alveolar-capillary membrane in ARDS, with potential implications for patient care.

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Hypercapnia outcome in COVID-19 acute respiratory distress syndrome patients on mechanical ventilator: A retrospective observational cohort

Sarwat Rasheed1,2, Sidra Javed1,2, Thanyat Rasheed3, Shaiza Farman1,2, Elisha Shalim1,2

1 Sindh Infectious Disease Hospital and Research Centre, Karachi, Pakistan
2 Dow University of Health Sciences, Karachi, Pakistan
3 Patel Hospital, Karachi, Pakistan

DOI: 10.2478/jccm-2025-0004

Introduction: Acute respiratory distress syndrome (ARDS) is characterized by progressive lung inflammation which leads to increased dead space that can cause hypercapnia and can increase the risk of patient morbidity and mortality. In an attempt to improve ARDS patient outcomes provision of protective lung ventilation has been shown to improve patient mortality but increases the incidence of hypercapnia. Therefore, the role of carbon dioxide in ARDS remains contradicted by conflicted evidence. This study aims to examine this conflicting relationship between hypercapnia and mortality in mechanically ventilated COVID-19 ARDS patients.
Methods: We conducted a retrospective cohort study. The data was collected from the medical records of the patients admitted with COVID-19 ARDS in Sindh Infectious Disease Hospital &Research Centre (SIDH & RC) from August 2020 to August 2022 and who received mechanical ventilation for more than 48 hours. The patients were grouped into severe and no severe hypercapnia groups based on their arterial blood carbon dioxide levels (PaCO2). To understand the effect of hypercapnia on mortality we performed multivariable logistic regression, and inverse probability-weighted regression to adjust for time-varying confounders.
Results: We included 288 patients to detect at least 3% of the effect on mortality. Our analysis revealed an association of severe hypercapnia with severe lung injury, low PaO2/FiO2, high dead space, and poor compliance. In univariate analysis severe hypercapnia showed higher mortality: OR=3.50, 95% CI (1.46-8.43). However, after, adjusting for disease severity hypercapnia is not found to be associated with mortality: OR=1.08, 95% CI (0.32 -3.64). The sensitive analysis with weighted regression also shows no significant effect on mortality: OR=1.04, 95% CI (0.95-1.14).
Conclusion: This study showed that hypercapnia is not associated with mortality in COVID-19 ARDS patients.

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