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. 2021 Oct;47(10):1130-1139.
doi: 10.1007/s00134-021-06519-7. Epub 2021 Sep 16.

Role of total lung stress on the progression of early COVID-19 pneumonia

Silvia Coppola  1 , Davide Chiumello  1 , Mattia Busana  2 , Emanuele Giola  1 , Paola Palermo  2 , Tommaso Pozzi  1 , Irene Steinberg  2 , Stefano Roli  1 , Federica Romitti  2 , Stefano Lazzari  2 , Simone Gattarello  2 , Michela Palumbo  2 , Peter Herrmann  2 , Leif Saager  2 , Michael Quintel  2   3 , Konrad Meissner  2 , Luigi Camporota  4 , John J Marini  5 , Stefano Centanni  6 , Luciano Gattinoni  7
Affiliations

Role of total lung stress on the progression of early COVID-19 pneumonia

Silvia Coppola et al. Intensive Care Med. 2021 Oct.

Erratum in

  • Correction to: Role of total lung stress on the progression of early COVID‑19 pneumonia.
    Coppola S, Chiumello D, Busana M, Giola E, Palermo P, Pozzi T, Steinberg I, Roli S, Romitti F, Lazzari S, Gattarello S, Palumbo M, Herrmann P, Saager L, Quintel M, Meissner K, Camporota L, Marini JJ, Centanni S, Gattinoni L. Coppola S, et al. Intensive Care Med. 2022 Mar;48(3):387-388. doi: 10.1007/s00134-021-06589-7. Intensive Care Med. 2022. PMID: 34905078 Free PMC article. No abstract available.

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 PaO2/FiO2 (day 1): non-CARDS (median PaO2/FiO2 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: PaO2/FiO2 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.

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Conflict of interest statement

LG reports a consultancy for General Electrics and SIDAM. He also receives lecture fees from Estor and Dimar. LS reports financial relationships with Medtronic, Ferrer Deutschland and Merck.

Figures

Fig. 1
Fig. 1
Panel A: PaO2/FiO2 ratio measured at day 1 in the non-CARDS and CARDS subgroups (p < 0.001). Panel B: lung computed tomography features at day 1 as evaluated by the quantitative analysis in the five subgroups (over-inflated tissue, p = 0.30; normally inflated tissue, p = 0.31; poorly inflated tissue, p = 0.91; non-inflated tissue p = 0.74). The PaO2/FiO2 ratio decreased across the subgroups by ~ 300 mmHg, while the associated anatomical features were nearly identical.
Fig. 2
Fig. 2
Left panel: daily time course of the PaO2/FiO2 ratio, in the single patient, with positive outcome (red color) and negative outcome (blue color). Right panel: daily time course of the total lung stress, in the single patient, with positive outcome (red color) and negative outcome (blue color)
See this image and copyright information in PMC

Comment in

References

    1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 doi: 10.1001/jama.2012.5669. - DOI - PubMed
    1. Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Covid-19 Does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020 doi: 10.1007/s00134-020-06281-2. - DOI - PMC - PubMed
    1. Chiumello D, Busana M, Coppola S, Romitti F, Formenti P, Bonifazi M, Pozzi T, Palumbo MM, Cressoni M, Herrmann P, Meissner K, Quintel M, Camporota L, Marini JJ, Gattinoni L. Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06281-2. - DOI - PMC - PubMed
    1. Marini JJ, Gattinoni L. Management of COVID-19 Respiratory Distress. JAMA. 2020 doi: 10.1001/jama.2020.6825. - DOI - PubMed
    1. Gattinoni L, D'Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA. 1993 doi: 10.1001/jama.1993.03500160092039. - DOI - PubMed

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