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Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation.
Dalpiaz, Giorgia; Gamberini, Lorenzo; Carnevale, Aldo; Spadaro, Savino; Mazzoli, Carlo Alberto; Piciucchi, Sara; Allegri, Davide; Capozzi, Chiara; Neziri, Ersenad; Bartolucci, Maurizio; Muratore, Francesco; Coppola, Francesca; Poerio, Antonio; Giampalma, Emanuela; Baldini, Luca; Tonetti, Tommaso; Cappellini, Iacopo; Colombo, Davide; Zani, Gianluca; Mellini, Lorenzo; Agnoletti, Vanni; Damiani, Federica; Gordini, Giovanni; Laici, Cristiana; Gola, Giuliano; Potalivo, Antonella; Montomoli, Jonathan; Ranieri, Vito Marco; Russo, Emanuele; Taddei, Stefania; Volta, Carlo Alberto; Scaramuzzo, Gaetano.
  • Dalpiaz G; Department of Radiology, Bellaria Hospital, Bologna, Italy.
  • Gamberini L; Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy. lorenzo.gamberini86@gmail.com.
  • Carnevale A; Department of Radiology, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy.
  • Spadaro S; Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy.
  • Mazzoli CA; Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
  • Piciucchi S; Department of Radiology, G. B. Morgagni Hospital, Forlì, Italy.
  • Allegri D; Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy.
  • Capozzi C; IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
  • Neziri E; Radiology Department, SS. Trinità Hospital, ASL Novara, Borgomanero, Italy.
  • Bartolucci M; Radiology Department, Azienda USL Toscana Centro, Prato, Italy.
  • Muratore F; Radiology Department, Infermi Hospital, Rimini, Italy.
  • Coppola F; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
  • Poerio A; Department of Radiology, Imola Hospital, Imola, Italy.
  • Giampalma E; Radiology Department, M. Bufalini Hospital, Cesena, Italy.
  • Baldini L; Department of Radiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
  • Tonetti T; Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
  • Cappellini I; Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy.
  • Colombo D; Traslational Medicine Department, Eastern Piedmont University, Novara, Italy.
  • Zani G; Anesthesiology Department, SS. Trinità Hospital, ASL Novara, Borgomanero, Italy.
  • Mellini L; Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy.
  • Agnoletti V; Department of Radiology, Santa Maria Delle Croci Hospital, Ravenna, Italy.
  • Damiani F; Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy.
  • Gordini G; Department of Anaesthesia, Intensive Care and Pain Therapy, Imola Hospital, Imola, Italy.
  • Laici C; Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
  • Gola G; Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Potalivo A; Department of Radiology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
  • Montomoli J; Department of Anaesthesia and Intensive Care, Ospedale degli Infermi, Faenza, Italy.
  • Ranieri VM; Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy.
  • Russo E; Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
  • Taddei S; Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy.
  • Volta CA; Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy.
  • Scaramuzzo G; Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy.
Radiol Med ; 127(2): 162-173, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1626023
ABSTRACT

PURPOSE:

COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. MATERIAL AND

METHODS:

All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected.

RESULTS:

A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning.

CONCLUSIONS:

The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. TRIAL REGISTRATION NCT04411459.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Tomography, X-Ray Computed / Microvessels / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Radiol Med Year: 2022 Document Type: Article Affiliation country: S11547-021-01444-7

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Tomography, X-Ray Computed / Microvessels / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Radiol Med Year: 2022 Document Type: Article Affiliation country: S11547-021-01444-7