Mechanical ventilation in patients with acute respiratory distress syndrome due to Covid-19 in an intensive care unit in Lima, Peru




Mechanical ventilation, acute respiratory distress syndrome, coronavirus infections


Objectives: To describe clinical, epidemiological, mechanical ventilation (MV) parameters and to determine overall mortality and that related to MV parameters in patients with acute respiratory distress syndrome (ARDS) in an ICU in Lima, Peru. Methods: A retrospective cohort including 133 patients with ARDS due to Covid-19 requiring MV in the Hospital Cayetano Heredia’s ICU was built from March to November 2020. Results: Males accounted for 75% of the cohort; 68% had no comorbidities; 97% has severe ARDS and 82% received extended 72h prone MV. Overall mortality was 38%; bivariate analysis found that alive patients had lower plateau pressure 27±1 cm H20 vs. 30±1 cm H20 (p=0.007), lower driving pressure 15±4 vs. 17±5 (p=0.008), higher static lung compliance 32±1 vs. 28±1 ml/cm H20 (p=0.01) and higher Pa02/Fi02 ratio 194±86 mm Hg vs. 157±66 mm Hg (p=0.01) than patients who died. Patients on extended prone MV had better survival (p=0.03). Conclusions: 97% of patients in the cohort had severe ARDS; overall mortality was 38%, alive patients had lower plateau pressure and less driving pressure and extended prone MV improved survival.


Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020; 323: 709–10.

World Health Organization‎. COVID-19 clinical management: living guidance. Ginebra: World Health Organization; 2021. (Citado el 15 de diciembre del 2021) Disponible en: https://apps.who. int/iris/handle/10665/338882

ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 20;307(23):2526-33. doi: 10.1001/ jama.2012.5669

Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: diferent respiratory treatments for diferent phenotypes? Intensive Care Med. 2020; 46:1099– 1102.

The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342:1301-1308.

Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372:747-755.

Guérin C, Reignier J, Richard J, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368:2159-2168.

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20): 2052–2059. doi:10.1001/ jama.2020.6775

Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020; 323(16):1612– 1614. doi: 10.1001/jama.2020.4326

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475–81. doi: 10.1016/S2213-2600(20)30079-5.

Mitra AR, Fergusson NA, Lloyd-Smith E, et al. Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series. CMAJ. 2020; 192(26): E694-E701. doi: 10.1503/cmaj.200794.

Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574- 1581. doi:10.1001/jama.2020.5394

Rahim F, Amin S, Noor M, et al. Mortality of Patients with Severe COVID-19 in the Intensive Care Unit: An Observational Study from a Major COVID-19 Receiving Hospital. Cureus. 2020; 12(10):e10906. doi:10.7759/cureus.10906

Grasselli G, Cattaneo E, Florio G, et al. Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review. Crit Care. 2021; 25: 115. Doi: 10.1186/s13054-021-03536-2

Bos LDJ, Paulus F, Vlaar APJ, Beenen LFM, Schultz MJ. Sub phenotyping acute respiratory distress syndrome in patients with COVID-19: consequences for ventilator management. Ann Am Thorac Soc. 2020; 17:1161–3.

Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020; 395:1763– 70.

Diehl JL, Peron N, Chocron R, et al. Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study. Ann Intensive Care. 2020; 10:95.

Grasselli G, Tonetti T, Protti A, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med. 2020; 8(12):1201-1208. doi: 10.1016/S2213-2600(20)30370-2

Cornejo R, Ugalde D, Muñoz M, et al. Efectos de la ventilación en posición prono extendida en SDRA secundario a influenza A(H1N1). Rev chil med intensive. 2011; 26(1): 17-26.

Carsetti A, Paciarini A, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care. 2020; 24:225.



How to Cite

Zegarra Piérola J, Fernández Merjildo D, Lévano Díaz L, Ticona Salazar J. Mechanical ventilation in patients with acute respiratory distress syndrome due to Covid-19 in an intensive care unit in Lima, Peru. Rev Med Hered [Internet]. 2022 Jul. 6 [cited 2024 Apr. 15];33(2):81-90. Available from:




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