tetano
Editor, Senior Moderator
Respir Care
. 2024 Apr 9:respcare.11625.
doi: 10.4187/respcare.11625. Online ahead of print. Quantitative CT scan and response to pronation in COVID-19 ARDS
Francesco Zadek[SUP] 1 [/SUP], Luca Berta[SUP] 2 [/SUP], Giulia Zorzi[SUP] 2 3 [/SUP], Stefania Ubiali[SUP] 4 [/SUP], Amos Bonaiuti[SUP] 1 [/SUP], Giulia Tundo[SUP] 1 [/SUP], Beatrice Brunoni[SUP] 1 [/SUP], Francesco Marrazzo[SUP] 5 [/SUP], Riccardo Giudici[SUP] 5 [/SUP], Anna Rossi[SUP] 5 [/SUP], Francesco Rizzetto[SUP] 6 [/SUP], Davide Paolo Bernasconi[SUP] 7 [/SUP], Angelo Vanzulli[SUP] 6 8 [/SUP], Paola Enrica Colombo[SUP] 2 [/SUP], Roberto Fumagalli[SUP] 1 5 [/SUP], Alberto Torresin[SUP] 2 [/SUP], Thomas Langer[SUP] 1 5 [/SUP]
Affiliations
Background: The use of the prone position (PP) has been widespread during the COVID-19 pandemic. While it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative Computed Tomography (qCT) scan results and gas exchange response to PP in intubated, mechanically ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline qCT results between subjects responding to PP in terms of oxygenation or carbon dioxide (CO[SUB]2[/SUB]) clearance and those who did not.Methods: This was a single-center, retrospective observational study, including critically ill, intubated, mechanically ventilated subjects with COVID-19 related acute respiratory distress syndrome admitted to the ICUs of Niguarda Hospital between March 2020 and November 2021. Blood-gas samples were collected before and after PP. Subjects in whom the PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] increase was ≥ 20 mmHg after PP were defined as Oxygen responders (Oxy-R). CO[SUB]2[/SUB]-responders (CO[SUB]2[/SUB]R) were defined when the ventilatory ratio (VR) decreased during PP. Automated qCT analyses were performed to obtain tissue mass and density of the lungs.Results: One hundred twenty-five subjects were enrolled, of which 116 (93%) were Oxy-R and 51 (41%) CO[SUB]2[/SUB]R. No difference in qCT characteristics and oxygen were observed between Oxy-R and Oxygen Non Responders (Tissue mass 1532 ±396 vs. 1654 ±304 g, p= .28; density -544±109 vs. -562±58 HU, p= .42). Similar findings were observed when dividing the population according to CO[SUB]2[/SUB] response (Tissue mass 1551±412 vs. 1534±377 g, p= .89; density -545±123 vs. -546±94 HU, p= .99).Conclusions: Most COVID-19 related ARDS subjects improve their oxygenation at the first pronation cycle. The study suggests that baseline qCT scan data are not associated with the response to PP in oxygenation or CO[SUB]2[/SUB] in mechanically ventilated COVID-19 related ARDS subjects.
Keywords: COVID-19 ARDS; Computed Tomography Scanner; Coronavirus Severe Acute Respiratory Syndrome; Lung compliance; Prone position; Pulmonary Gas Exchange; Quantitative CT scan analysis; Ventilation-Perfusion Scan.
. 2024 Apr 9:respcare.11625.
doi: 10.4187/respcare.11625. Online ahead of print. Quantitative CT scan and response to pronation in COVID-19 ARDS
Francesco Zadek[SUP] 1 [/SUP], Luca Berta[SUP] 2 [/SUP], Giulia Zorzi[SUP] 2 3 [/SUP], Stefania Ubiali[SUP] 4 [/SUP], Amos Bonaiuti[SUP] 1 [/SUP], Giulia Tundo[SUP] 1 [/SUP], Beatrice Brunoni[SUP] 1 [/SUP], Francesco Marrazzo[SUP] 5 [/SUP], Riccardo Giudici[SUP] 5 [/SUP], Anna Rossi[SUP] 5 [/SUP], Francesco Rizzetto[SUP] 6 [/SUP], Davide Paolo Bernasconi[SUP] 7 [/SUP], Angelo Vanzulli[SUP] 6 8 [/SUP], Paola Enrica Colombo[SUP] 2 [/SUP], Roberto Fumagalli[SUP] 1 5 [/SUP], Alberto Torresin[SUP] 2 [/SUP], Thomas Langer[SUP] 1 5 [/SUP]
Affiliations
- PMID: 38594036
- DOI: 10.4187/respcare.11625
Background: The use of the prone position (PP) has been widespread during the COVID-19 pandemic. While it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative Computed Tomography (qCT) scan results and gas exchange response to PP in intubated, mechanically ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline qCT results between subjects responding to PP in terms of oxygenation or carbon dioxide (CO[SUB]2[/SUB]) clearance and those who did not.Methods: This was a single-center, retrospective observational study, including critically ill, intubated, mechanically ventilated subjects with COVID-19 related acute respiratory distress syndrome admitted to the ICUs of Niguarda Hospital between March 2020 and November 2021. Blood-gas samples were collected before and after PP. Subjects in whom the PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] increase was ≥ 20 mmHg after PP were defined as Oxygen responders (Oxy-R). CO[SUB]2[/SUB]-responders (CO[SUB]2[/SUB]R) were defined when the ventilatory ratio (VR) decreased during PP. Automated qCT analyses were performed to obtain tissue mass and density of the lungs.Results: One hundred twenty-five subjects were enrolled, of which 116 (93%) were Oxy-R and 51 (41%) CO[SUB]2[/SUB]R. No difference in qCT characteristics and oxygen were observed between Oxy-R and Oxygen Non Responders (Tissue mass 1532 ±396 vs. 1654 ±304 g, p= .28; density -544±109 vs. -562±58 HU, p= .42). Similar findings were observed when dividing the population according to CO[SUB]2[/SUB] response (Tissue mass 1551±412 vs. 1534±377 g, p= .89; density -545±123 vs. -546±94 HU, p= .99).Conclusions: Most COVID-19 related ARDS subjects improve their oxygenation at the first pronation cycle. The study suggests that baseline qCT scan data are not associated with the response to PP in oxygenation or CO[SUB]2[/SUB] in mechanically ventilated COVID-19 related ARDS subjects.
Keywords: COVID-19 ARDS; Computed Tomography Scanner; Coronavirus Severe Acute Respiratory Syndrome; Lung compliance; Prone position; Pulmonary Gas Exchange; Quantitative CT scan analysis; Ventilation-Perfusion Scan.