ArticleCritical care explorations2026
Performance of the Ventilatory Ratio to Predict Intubation in Patients With COVID-19 Acute Respiratory Distress Syndrome.
Article in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesVentilatory ratio (VR) could be a useful marker of COVID-19 acute respiratory distress syndrome (ARDS) worsening, since its value has been shown to correlate with dead space and severity of non-COVID-19 ARDS. In this study, we sought to: 1) compare VR to the estimated intrapulmonary shunt and the Pao2/Fio2 ratio for the association with the risk of intubation and 2) define the best VR threshold to discriminate between intubated patients and nonintubated patients.
designMulticenter, prospective experimental study.
settingICUs from University and General Hospitals. PATIENTS: Patients with moderate-to-severe COVID-19 ARDS.
interventionsWe conducted standardized continuous positive airway pressure sessions with an Fio2 of 100% and positive end-expiratory pressure of 5 cm H2O to calculate the Pao2/Fio2 ratio, the estimated intrapulmonary shunt (indexed on cardiac output), and VR. These sessions were repeated until intubation or ICU discharge. A time-dependent joint multivariable model was performed. MEASUREMENTS AND MAIN
resultsFifty-two patients were included, 25 of whom required intubation (48%). Among studied variables including the Pao2/Fio2 ratio and the estimated intrapulmonary shunt, VR was most associated with the longitudinal risk of intubation with a hazard ratio (HR, 3.30; 97.5% CI, 1.42-8.91; p = 0.001) compare to the Pao2/Fio2 ratio with HR (0.98; 97.5% CI, 0.97-0.99; p = 0.002) and the estimated intrapulmonary shunt with HR (2.31; 97.5% CI, 0.37-24.01; p = 0.394). The best VR threshold values were identified at day 1 (VR = 2.1, sensitivity, 85.7%; specificity, 60.1%; area under the receiver operating characteristic curve [AUC] = 0.810), day 3 (VR = 2.3; sensitivity, 92.0%; specificity, 91.2%; AUC = 0.973), and day 5 (VR = 2; sensitivity, 92%; specificity, 97%; AUC = 0.979) to discriminate intubated and nonintubated patients.
conclusionsThe study provides valuable insights into COVID-19 ARDS, highlighting VR as a reliable and objective predictor of intubation. Increased VR could be a critical marker of lung injury progression in patients with ARDS.
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