reported in 10 intubated COVID-19 ARDS patients a large variability in potential for lung recruitment together with an elevated dead space fraction evaluated by electrical impedance tomography (EIT). Low recruitability, improved by body positioning, has been reported by some authors, while others mentioned that most of the patients were highly recruitable. Such reported features are severe hypoxemia contrasting with relative preservation in respiratory mechanics, and a common hypercapnia with high ventilatory ratio (VR). Patients with Covid-19 pneumonia fulfilling Berlin criteria of ARDS may present some specific features, as compared to typical forms of the syndrome. High V D/ V T can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process. We observed early in the course of COVID-19 ARDS high V D/ V T in association with biological markers of endothelial damage and thrombosis. CECs and D-dimers were elevated as compared to normal values: 24 cells per mL and 1483 ng/mL, respectively. No pulmonary embolism was suspected at the time of measurements. V D/ V T and VR were significantly correlated: r 2 = 0.24, p = 0.014. Gas exchanges were characterized by hypercapnia 55 mmHg, high physiological dead-space ( V D/ V T): 75 % and ventilatory ratio (VR): 2.9. We observed moderately decreased respiratory system compliance: 39.5 mL/cmH 2O and end-expiratory lung volume: 2100 mL. Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. Methodsīetween March 22 and Marespiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 day after intubation (median ). Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. COVID-19 ARDS could differ from typical forms of the syndrome.
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