Dataset Information

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.

ABSTRACT:

Purpose

To investigate whether COVID-19-ARDS differs from all-cause ARDS.

Methods

Thirty-two consecutive, mechanically ventilated COVID-19-ARDS patients were compared to two historical ARDS sub-populations 1:1 matched for PaO₂/FiO₂ or for compliance of the respiratory system. Gas exchange, hemodynamics and respiratory mechanics were recorded at 5 and 15 cmH₂O PEEP. CT scan variables were measured at 5 cmH₂O PEEP.

Results

Anthropometric characteristics were similar in COVID-19-ARDS, PaO₂/FiO₂-matched-ARDS and Compliance-matched-ARDS. The PaO₂/FiO₂-matched-ARDS and COVID-19-ARDS populations (both with PaO₂/FiO₂ 106?±?59 mmHg) had different respiratory system compliances (Crs) (39?±?11 vs 49.9?±?15.4 ml/cmH₂O, p?=?0.03). The Compliance-matched-ARDS and COVID-19-ARDS had similar Crs (50.1?±?15.7 and 49.9?±?15.4 ml/cmH₂O, respectively) but significantly lower PaO₂/FiO₂ for the same Crs (160?±?62 vs 106.5?±?59.6 mmHg, p?2/FiO₂-matched-ARDS 930?±?644 ml, COVID-19-ARDS 1670?±?791 ml and Compliance-matched-ARDS 1301?±?627 ml, p?2/FiO₂-matched-ARDS and Compliance-matched-ARDS (p?2O improved oxygenation in all groups. However, while lung mechanics and dead space improved in PaO₂/FiO₂-matched-ARDS, suggesting recruitment as primary mechanism, they remained unmodified or worsened in COVID-19-ARDS and Compliance-matched-ARDS, suggesting lower recruitment potential and/or blood flow redistribution.

Conclusions

COVID-19-ARDS is a subset of ARDS characterized overall by higher compliance and lung gas volume for a given PaO₂/FiO₂, at least when considered within the timeframe of our study.

SUBMITTER: Chiumello D

PROVIDER: S-EPMC7577365 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.

Chiumello Davide D Busana Mattia M Coppola Silvia S Romitti Federica F Formenti Paolo P Bonifazi Matteo M Pozzi Tommaso T Palumbo Maria Michela MM Cressoni Massimo M Herrmann Peter P Meissner Konrad K Quintel Michael M Camporota Luigi L Marini John J JJ Gattinoni Luciano L

Intensive care medicine 20201021 12

<h4>Purpose</h4>To investigate whether COVID-19-ARDS differs from all-cause ARDS.<h4>Methods</h4>Thirty-two consecutive, mechanically ventilated COVID-19-ARDS patients were compared to two historical ARDS sub-populations 1:1 matched for PaO<sub>2</sub>/FiO<sub>2</sub> or for compliance of the respiratory system. Gas exchange, hemodynamics and respiratory mechanics were recorded at 5 and 15 cmH<sub>2</sub>O PEEP. CT scan variables were measured at 5 cmH<sub>2</sub>O PEEP.<h4>Results</h4>Anthropom ...[more]

PMID: 33089348

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Project description:(1) Background: Respiratory insufficiency with acute respiratory distress syndrome (ARDS) and multi-organ dysfunction leads to high mortality in COVID-19 patients. In times of limited intensive care unit (ICU) resources, chest CTs became an important tool for the assessment of lung involvement and for patient triage despite uncertainties about the predictive diagnostic value. This study evaluated chest CT-based imaging parameters for their potential to predict in-hospital mortality compared to clinical scores. (2) Methods: 89 COVID-19 ICU ARDS patients requiring mechanical ventilation or continuous positive airway pressure mask ventilation were included in this single center retrospective study. AI-based lung injury assessment and measurements indicating pulmonary hypertension (PA-to-AA ratio) on admission CT, oxygenation indices, lung compliance and sequential organ failure assessment (SOFA) scores on ICU admission were assessed for their diagnostic performance to predict in-hospital mortality. (3) Results: CT severity scores and PA-to-AA ratios were not significantly associated with in-hospital mortality, whereas the SOFA score showed a significant association (p < 0.001). In ROC analysis, the SOFA score resulted in an area under the curve (AUC) for in-hospital mortality of 0.74 (95%-CI 0.63-0.85), whereas CT severity scores (0.53, 95%-CI 0.40-0.67) and PA-to-AA ratios (0.46, 95%-CI 0.34-0.58) did not yield sufficient AUCs. These results were consistent for the subgroup of more critically ill patients with moderate and severe ARDS on admission (oxygenation index <200, n = 53) with an AUC for SOFA score of 0.77 (95%-CI 0.64-0.89), compared to 0.55 (95%-CI 0.39-0.72) for CT severity scores and 0.51 (95%-CI 0.35-0.67) for PA-to-AA ratios. (4) Conclusions: Severe COVID-19 disease is not limited to lung (vessel) injury but leads to a multi-organ involvement. The findings of this study suggest that risk stratification should not solely be based on chest CT parameters but needs to include multi-organ failure assessment for COVID-19 ICU ARDS patients for optimized future patient management and resource allocation.

Dataset Information

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.

Purpose

Methods

Results

Conclusions

Publications

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.

Similar Datasets

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