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Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
Chiumello, Davide; Busana, Mattia; Coppola, Silvia; Romitti, Federica; Formenti, Paolo; Bonifazi, Matteo; Pozzi, Tommaso; Palumbo, Maria Michela; Cressoni, Massimo; Herrmann, Peter; Meissner, Konrad; Quintel, Michael; Camporota, Luigi; Marini, John J; Gattinoni, Luciano.
Afiliação
  • Chiumello D; Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Milan, Italy.
  • Busana M; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Coppola S; Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Milan, Italy.
  • Romitti F; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Formenti P; Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Milan, Italy.
  • Bonifazi M; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Pozzi T; Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Milan, Italy.
  • Palumbo MM; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Cressoni M; Department of Radiology, San Gerardo Hospital, Monza, Italy.
  • Herrmann P; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Meissner K; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Quintel M; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
  • Camporota L; Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, UK.
  • Marini JJ; Department of Pulmonary and Critical Care Medicine, University of Minnesota and Regions Hospital, St. Paul, Minnesota, USA.
  • Gattinoni L; Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany. gattinoniluciano@gmail.com.
Intensive Care Med ; 46(12): 2187-2196, 2020 12.
Article em En | MEDLINE | ID: mdl-33089348
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 < 0.001). The three populations had similar lung weights but COVID-19-ARDS had significantly higher lung gas volume (PaO2/FiO2-matched-ARDS 930 ± 644 ml, COVID-19-ARDS 1670 ± 791 ml and Compliance-matched-ARDS 1301 ± 627 ml, p < 0.05). The venous admixture was significantly related to the non-aerated tissue in PaO2/FiO2-matched-ARDS and Compliance-matched-ARDS (p < 0.001) but unrelated in COVID-19-ARDS (p = 0.75), suggesting that hypoxemia was not only due to the extent of non-aerated tissue. Increasing PEEP from 5 to 15 cmH2O 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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / COVID-19 Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Intensive Care Med Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / COVID-19 Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Intensive Care Med Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Itália