Associations of Body Mass Index with Ventilation Management and Clinical Outcomes in Invasively Ventilated Patients with ARDS Related to COVID-19-Insights from the PRoVENT-COVID Study

Renee Schavemaker, Marcus J. Schultz, Wim K. Lagrand, Eline R. van Slobbe-Bijlsma, Ary Serpa Neto, Frederique Paulus*, PRoVENT-COVID Collaborative Group, Dennis Bergmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Web of Science)


We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m 2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m 2), and obese (BMI > 30 kg/m 2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end– expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal–weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study: 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient’s BMI should not be used in decisions to forgo or proceed with invasive ventilation.

Original languageEnglish
Article number1176
Pages (from-to)1-14
Number of pages14
JournalJournal of Clinical Medicine
Issue number6
Publication statusPublished - 2 Mar 2021


  • coronavirus disease 2019
  • COVID-19
  • ARDS
  • body mass index
  • BMI
  • normal-weight overweight
  • obesity
  • obesity paradox
  • intensive care
  • critical care
  • artificial ventilation
  • mortality

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