tetano
Editor, Senior Moderator
Intensive Care Med
. 2021 Sep 16;1-10.
doi: 10.1007/s00134-021-06519-7. Online ahead of print.
Role of total lung stress on the progression of early COVID-19 pneumonia
Silvia Coppola[SUP] 1 [/SUP], Davide Chiumello[SUP] 1 [/SUP], Mattia Busana[SUP] 2 [/SUP], Emanuele Giola[SUP] 1 [/SUP], Paola Palermo[SUP] 2 [/SUP], Tommaso Pozzi[SUP] 1 [/SUP], Irene Steinberg[SUP] 2 [/SUP], Stefano Roli[SUP] 1 [/SUP], Federica Romitti[SUP] 2 [/SUP], Stefano Lazzari[SUP] 2 [/SUP], Simone Gattarello[SUP] 2 [/SUP], Michela Palumbo[SUP] 2 [/SUP], Peter Herrmann[SUP] 2 [/SUP], Leif Saager[SUP] 2 [/SUP], Michael Quintel[SUP] 2 3 [/SUP], Konrad Meissner[SUP] 2 [/SUP], Luigi Camporota[SUP] 4 [/SUP], John J Marini[SUP] 5 [/SUP], Stefano Centanni[SUP] 6 [/SUP], Luciano Gattinoni[SUP] 7 [/SUP]
Affiliations
Abstract
Purpose: We investigated if the stress applied to the lung during non-invasive respiratory support may contribute to the coronavirus disease 2019 (COVID-19) progression.
Methods: Single-center, prospective, cohort study of 140 consecutive COVID-19 pneumonia patients treated in high-dependency unit with continuous positive airway pressure (n = 131) or non-invasive ventilation (n = 9). We measured quantitative lung computed tomography, esophageal pressure swings and total lung stress.
Results: Patients were divided in five subgroups based on their baseline PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] (day 1): non-CARDS (median PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 361 mmHg, IQR [323-379]), mild (224 mmHg [211-249]), mild-moderate (173 mmHg [164-185]), moderate-severe (126 mmHg [114-138]) and severe (88 mmHg [86-99], p < 0.001). Each subgroup had similar median lung weight: 1215 g [1083-1294], 1153 [888-1321], 968 [858-1253], 1060 [869-1269], and 1127 [937-1193] (p = 0.37). They also had similar non-aerated tissue fraction: 10.4% [5.9-13.7], 9.6 [7.1-15.8], 9.4 [5.8-16.7], 8.4 [6.7-12.3] and 9.4 [5.9-13.8], respectively (p = 0.85). Treatment failure of CPAP/NIV occurred in 34 patients (24.3%). Only three variables, at day one, distinguished patients with negative outcome: PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR 0.99 [0.98-0.99], p = 0.02), esophageal pressure swing (OR 1.13 [1.01-1.27], p = 0.032) and total stress (OR 1.17 [1.06-1.31], p = 0.004). When these three variables were evaluated together in a multivariate logistic regression analysis, only the total stress was independently associated with negative outcome (OR 1.16 [1.01-1.33], p = 0.032).
Conclusions: In early COVID-19 pneumonia, hypoxemia is not linked to computed tomography (CT) pathoanatomy, differently from typical ARDS. High lung stress was independently associated with the failure of non-invasive respiratory support.
Keywords: ARDS; COVID-19; Computed tomography scan; Lung stress; Mechanical ventilation; Non-invasive respiratory support; Ventilation-induced lung injury.
. 2021 Sep 16;1-10.
doi: 10.1007/s00134-021-06519-7. Online ahead of print.
Role of total lung stress on the progression of early COVID-19 pneumonia
Silvia Coppola[SUP] 1 [/SUP], Davide Chiumello[SUP] 1 [/SUP], Mattia Busana[SUP] 2 [/SUP], Emanuele Giola[SUP] 1 [/SUP], Paola Palermo[SUP] 2 [/SUP], Tommaso Pozzi[SUP] 1 [/SUP], Irene Steinberg[SUP] 2 [/SUP], Stefano Roli[SUP] 1 [/SUP], Federica Romitti[SUP] 2 [/SUP], Stefano Lazzari[SUP] 2 [/SUP], Simone Gattarello[SUP] 2 [/SUP], Michela Palumbo[SUP] 2 [/SUP], Peter Herrmann[SUP] 2 [/SUP], Leif Saager[SUP] 2 [/SUP], Michael Quintel[SUP] 2 3 [/SUP], Konrad Meissner[SUP] 2 [/SUP], Luigi Camporota[SUP] 4 [/SUP], John J Marini[SUP] 5 [/SUP], Stefano Centanni[SUP] 6 [/SUP], Luciano Gattinoni[SUP] 7 [/SUP]
Affiliations
- PMID: 34529118
- PMCID: PMC8444534
- DOI: 10.1007/s00134-021-06519-7
Abstract
Purpose: We investigated if the stress applied to the lung during non-invasive respiratory support may contribute to the coronavirus disease 2019 (COVID-19) progression.
Methods: Single-center, prospective, cohort study of 140 consecutive COVID-19 pneumonia patients treated in high-dependency unit with continuous positive airway pressure (n = 131) or non-invasive ventilation (n = 9). We measured quantitative lung computed tomography, esophageal pressure swings and total lung stress.
Results: Patients were divided in five subgroups based on their baseline PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] (day 1): non-CARDS (median PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 361 mmHg, IQR [323-379]), mild (224 mmHg [211-249]), mild-moderate (173 mmHg [164-185]), moderate-severe (126 mmHg [114-138]) and severe (88 mmHg [86-99], p < 0.001). Each subgroup had similar median lung weight: 1215 g [1083-1294], 1153 [888-1321], 968 [858-1253], 1060 [869-1269], and 1127 [937-1193] (p = 0.37). They also had similar non-aerated tissue fraction: 10.4% [5.9-13.7], 9.6 [7.1-15.8], 9.4 [5.8-16.7], 8.4 [6.7-12.3] and 9.4 [5.9-13.8], respectively (p = 0.85). Treatment failure of CPAP/NIV occurred in 34 patients (24.3%). Only three variables, at day one, distinguished patients with negative outcome: PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR 0.99 [0.98-0.99], p = 0.02), esophageal pressure swing (OR 1.13 [1.01-1.27], p = 0.032) and total stress (OR 1.17 [1.06-1.31], p = 0.004). When these three variables were evaluated together in a multivariate logistic regression analysis, only the total stress was independently associated with negative outcome (OR 1.16 [1.01-1.33], p = 0.032).
Conclusions: In early COVID-19 pneumonia, hypoxemia is not linked to computed tomography (CT) pathoanatomy, differently from typical ARDS. High lung stress was independently associated with the failure of non-invasive respiratory support.
Keywords: ARDS; COVID-19; Computed tomography scan; Lung stress; Mechanical ventilation; Non-invasive respiratory support; Ventilation-induced lung injury.