Acute Crit Care.  2021 Aug;36(3):223-231. 10.4266/acc.2021.00388.

Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome

• Khalid I
• Yamani RM
• Imran M
• Akhtar MA
• Imran M
• Gul R
• Khalid TJ
• Wali GY

• KMID: 2519449
• DOI: http://doi.org/10.4266/acc.2021.00388

Abstract

Background
Both coronavirus disease 2019 (COVID-19) and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERS patients with ARDS to evaluate this issue.
Methods
MERS patients with ARDS seen during the March to May 2014 outbreak and COVID-19 patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.
Results
Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO₂, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were high and reflective of their baseline comorbid status.
Conclusions
Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients might explain the greater steroid responsiveness in this population.

Keyword

acute respiratory distress syndrome; COVID-19; middle east respiratory syndrome coronavirus; mortality; outcome; ventilatory

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