Late Breaking Abstract - Associations of intensity of ventilation with mortality in COVID–19 patients with ARDS

Background: There is scant information about intensity of ventilation and mortality in COVID–19 patients with ARDS. Aim: To investigate the association between exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients Methods: Multicenter observational study in 734 COVID–19 patients with ARDS. ΔP and MP were calculated at fixed time points during the first 4 calendar days of ventilation using granular ventilation data. The primary endpoint was 28–day mortality. To assess the effects of time–varying exposure, Bayesian joint models adjusted for confounders were used. Results: In the first 28 days, 214 (29.2%) patients died. A significant increase in the hazard of death was associated with each increment in ΔP (HR 1.04 [95%–CrI 1.01–1.07]; P = 0.010) and in MP (HR 1.12 [95%–CrI 1.01–1.36]; P = 0.018). Cumulative exposure to higher levels of ΔP or MP were both associated with higher risk for 28–day mortality (Figure 1). Conclusions: Cumulative exposure to higher intensities of ventilation in COVID–19 patients with ARDS is associated with increased risk of 28–day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients.