Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study
Journal
Journal of Intensive Care Medicine
ISSN
0885-0666
Date Issued
2025-09-08
Author(s)
Martín H. Benites
Romina Battiato
Ronald Pairumani
Juan Nicolás Medel
Edward Petruska
Diego Ugalde
Felipe Morales
Daniela Eisen
Carla Araya
Jorge Montoya
Jaime Retamal
Eduardo Kattan
Roque Basoalto
Guillermo Bugedo
Emilio Daniel Valenzuela
Type
journal-article
Abstract
Purpose : An elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (C-ARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism. Materials and Methods : We studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used. Results : Of the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR >= 2. Patients with a VR >= 2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR >= 2. Mortality was significantly associated with VR >= 2 and driving pressure >= 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118). Conclusion : Elevated VR was associated with ACP in patients with C-ARDS. VR >= 2 combined with driving pressure >= 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality.
Cite this document
Benites, M. H., Battiato, R., Mercado, P., Pairumani, R., Medel, J. N., Petruska, E., Ugalde, D., Morales, F., Eisen, D., Araya, C., Montoya, J., Retamal, J., Kattan, E., Basoalto, R., Bugedo, G., & Valenzuela, E. D. (2025). Association of ventilatory ratio with acute cor pulmonale and mortality in covid-19 ards: A cohort study. Journal of Intensive Care Medicine, 08850666251359548. https://doi.org/10.1177/08850666251359548