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Assessment of Lung Reaeration at 2 Levels of Positive End-expiratory Pressure in Patients With Early and Late COVID-19-related Acute Respiratory Distress Syndrome.
Smit, Marry R; Beenen, Ludo F M; Valk, Christel M A; de Boer, Milou M; Scheerder, Maeke J; Annema, Jouke T; Paulus, Frederique; Horn, Janneke; Vlaar, Alexander P J; Kooij, Fabian O; Hollmann, Markus W; Schultz, Marcus J; Bos, Lieuwe D J.
  • Smit MR; Departments of Intensive Care.
  • Beenen LFM; Radiology and Nuclear Medicine.
  • Valk CMA; Departments of Intensive Care.
  • de Boer MM; Departments of Intensive Care.
  • Scheerder MJ; Radiology and Nuclear Medicine.
  • Annema JT; Respiratory Medicine.
  • Paulus F; Departments of Intensive Care.
  • Horn J; Departments of Intensive Care.
  • Vlaar APJ; Departments of Intensive Care.
  • Kooij FO; Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
  • Hollmann MW; Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
  • Schultz MJ; Departments of Intensive Care.
  • Bos LDJ; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
J Thorac Imaging ; 36(5): 286-293, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1440700
Semantic information from SemMedBD (by NLM)
1. Positive End-Expiratory Pressure TREATS Patients
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Patients
2. Respiratory Distress Syndrom PROCESS_OF C0030705
Subject
Respiratory Distress Syndrom
Predicate
PROCESS_OF
Object
C0030705
3. Disease PROCESS_OF Patients
Subject
Disease
Predicate
PROCESS_OF
Object
Patients
4. Lung consolidation PROCESS_OF Patients
Subject
Lung consolidation
Predicate
PROCESS_OF
Object
Patients
5. Chest CT ADMINISTERED_TO Patients
Subject
Chest CT
Predicate
ADMINISTERED_TO
Object
Patients
6. Positive End-Expiratory Pressure TREATS Patients
Subject
Positive End-Expiratory Pressure
Predicate
TREATS
Object
Patients
7. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
Subject
Respiratory Distress Syndrome, Adult
Predicate
PROCESS_OF
Object
Patients
8. Disease PROCESS_OF Patients
Subject
Disease
Predicate
PROCESS_OF
Object
Patients
9. Lung consolidation PROCESS_OF Patients
Subject
Lung consolidation
Predicate
PROCESS_OF
Object
Patients
10. Chest CT ADMINISTERED_TO Patients
Subject
Chest CT
Predicate
ADMINISTERED_TO
Object
Patients
ABSTRACT

PURPOSE:

Patients with novel coronavirus disease (COVID-19) frequently develop acute respiratory distress syndrome (ARDS) and need invasive ventilation. The potential to reaerate consolidated lung tissue in COVID-19-related ARDS is heavily debated. This study assessed the potential to reaerate lung consolidations in patients with COVID-19-related ARDS under invasive ventilation. MATERIALS AND

METHODS:

This was a retrospective analysis of patients with COVID-19-related ARDS who underwent chest computed tomography (CT) at low positive end-expiratory pressure (PEEP) and after a recruitment maneuver at high PEEP of 20 cm H2O. Lung reaeration, volume, and weight were calculated using both CT scans. CT scans were performed after intubation and start of ventilation (early CT), or after several days of intensive care unit admission (late CT).

RESULTS:

Twenty-eight patients were analyzed. The median percentages of reaerated and nonaerated lung tissue were 19% [interquartile range, IQR 10 to 33] and 11% [IQR 4 to 15] for patients with early and late CT scans, respectively (P=0.049). End-expiratory lung volume showed a median increase of 663 mL [IQR 483 to 865] and 574 mL [IQR 292 to 670] after recruitment for patients with early and late CT scans, respectively (P=0.43). The median decrease in lung weight attributed to nonaerated lung tissue was 229 g [IQR 165 to 376] and 171 g [IQR 81 to 229] after recruitment for patients with early and late CT scans, respectively (P=0.16).

CONCLUSIONS:

The majority of patients with COVID-19-related ARDS undergoing invasive ventilation had substantial reaeration of lung consolidations after recruitment and ventilation at high PEEP. Higher PEEP can be considered in patients with reaerated lung consolidations when accompanied by improvement in compliance and gas exchange.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Observational study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: J Thorac Imaging Journal subject: Diagnostic Imaging Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Observational study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: J Thorac Imaging Journal subject: Diagnostic Imaging Year: 2021 Document Type: Article