The following is the summary of “A Retrospective Analysis of the Effects of Time on Compliance and Driving Pressures in ARDS” published in the January 2023 issue of Respiratory Care by Jagan, et al.

There has not been enough research into the impact of noninvasive respiratory assistance on compliance and driving pressure over time in ARDS patients before they are intubated. Researchers performed this study to retrospectively describe the trajectory of static compliance and driving pressure in patients with COVID-19 and non-COVID-19 ARDS on mechanical ventilation, and to assess the effect of the duration of noninvasive respiratory support prior to intubation (ie, noninvasive ventilation [NIV], high-flow nasal cannula [HFNC], or a combination of NIV and HFNC).  This is a retrospective look at prospectively gathered data from three community hospitals in the suburbs, one rural magnet hospital, and an academic medical facility linked with a university. 

There were a total of 589 participants: 55 with COVID-19, 137 with positive cultures, and 397 without any cultures at all. Every 8 hours, the subject and ventilator were evaluated to determine the static compliance and driving pressure. The results showed that the longer a patient received noninvasive respiratory support prior to intubation, the lower their compliance and driving pressure were. Compliance decreased by 0.08 units per subject-ventilator assessment in COVID-19-positive subjects, but this change was not statistically significant (P=.24); in contrast, compliance increased by 0.12 and 0.18 units in COVID-19-negative subjects, respectively (both P<.05).

A similar but inverse pattern was observed for driving pressure. COVID-19 ARDS was linked to a more dire course, with no improvement in static compliance or driving pressures, compared to non-COVID-19 ARDS. There was no correlation between the number of days a patient received noninvasive respiratory support prior to intubation and mortality, however its usage was linked to lower overall compliance and driving pressure.

Source: rc.rcjournal.com/content/68/1/52