Journal article
Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study
Critical care (London, England), Vol.25(1), pp.214-214
06/21/2021
DOI: 10.1186/s13054-021-03610-9
PMCID: PMC8215486
PMID: 34154635
Abstract
Background: Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia.
Methods: This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue-shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support.
Results: Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24-49%] vs. 63% [44-68%], p < 0.001); and a larger extent of gas:blood volume mismatch (43% [30-49%] vs. 25% [14-28%], p = 0.001), due to higher shunt (23% [15-32%] vs. 5% [2-16%], p = 0.001) and non-aerated/non perfused regions (5% [3-10%] vs. 1% [0-2%], p = 0.001). The PaO2/FiO(2) ratio correlated positively with normally aerated tissue (rho = 0.730, p < 0.001) and negatively with the extent of gas-blood volume mismatch (rho = - 0.633, p < 0.001).
Conclusions: In critically ill patients with severe COVID-19 pneumonia, the need for invasive mechanical ventilation and oxygenation impairment were associated with loss of aeration and the extent of gas:blood volume mismatch.
Details
- Title: Subtitle
- Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study
- Creators
- Lorenzo Ball - University of GenoaChiara Robba - Univ Genoa, Dept Surg Sci & Integrated Diagnost DISC, Viale Benedetto XV 16, Genoa, ItalyJacob Herrmann - Harvard UniversitySarah E. Gerard - University of IowaYi Xin - University of PennsylvaniaMaura Mandelli - Ospedale Policlinico San MartinoDenise Battaglini - University of GenoaIole Brunetti - Ospedale Policlinico San MartinoGiuseppe Minetti - Ospedale Policlinico San MartinoSara Seitun - Ospedale Policlinico San MartinoGiulio Bovio - Ospedale Policlinico San MartinoAntonio Vena - IRCCS Oncol & Neurosci, Infect Dis Unit, Osped Policlin San Martino, Genoa, ItalyDaniele Roberto Giacobbe - University of GenoaMatteo Bassetti - Ospedale Policlinico San MartinoPatricia R. M. Rocco - Univ Fed Rio de Janeiro, Carlos Chagas Filho Inst Biophys, Lab Pulm Invest, Rio De Janeiro, BrazilMaurizio Cereda - University of PennsylvaniaRahim R. Rizi - University of PennsylvaniaLucio Castellan - Ospedale Policlinico San MartinoNicolo Patroniti - University of GenoaPaolo Pelosi - Universidade Federal do Rio de JaneiroCollaborators of the GECOVID (GEnoa COVID-19) group
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.25(1), pp.214-214
- DOI
- 10.1186/s13054-021-03610-9
- PMID
- 34154635
- PMCID
- PMC8215486
- NLM abbreviation
- Crit Care
- ISSN
- 1364-8535
- eISSN
- 1466-609X
- Publisher
- Springer Nature
- Number of pages
- 12
- Grant note
- 421067/2016-0 / Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq); Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ) E-26/210.181/2020 / Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro; Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio De Janeiro (FAPERJ)
- Language
- English
- Date published
- 06/21/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984306748202771
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