Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
复制标题
DOI：
10.1007/s00134-020-06281-2
复制
发表时间：
2020-12
影响因子：
38.9
通讯作者：
Gattinoni L
中科院分区：
文献类型：
--
作者：
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
探讨新冠肺炎急性呼吸窘迫综合征与全因急性呼吸窘迫综合征的不同之处。32名连续的机械通气的新冠肺炎急性呼吸窘迫综合征患者与两个历史上的急性呼吸窘迫综合征亚群进行了比较，两个亚群的PaO2/FiO2或呼吸系统顺应性1：1匹配。分别在呼气末呼气末5和15cmH2O时记录气体交换、血流动力学和呼吸力学。在5cmH2O的PEEP下测量CT扫描参数。新冠肺炎ARDS、PaO2/FiO2匹配ARDS和顺应性匹配ARDS的人体测量特征相似。PaO2/FiO2匹配的ARDS和新冠肺炎ARDS患者(PaO2/FiO2 106 ± 59)的呼吸系统顺应性(CRs)不同(39 ± 11vs 49.9 ± 15.4mlml/cmH2O，p = 0.03)。依从性配对ARDS组和新冠肺炎ARDS组CRs相似(分别为50.1MmH2O± 15.7和49.9MmH2O± ± 15.4nml/cmH2O)，但PaO2/FiO2显著低于相同CRS组(160MmHgVS 106.5 ± 59.6MmHgp <； 0.001)。3个人群的肺重量相似，但新冠肺炎ARDS患者的肺气量显著高于对照组(PaO_2/FiO_2匹配的ARDS 930 ± 644，新冠肺炎ARDS 1670 ± 791，顺应性ARDS 1301 ± 627，p <； 0.05)。在PaO_2/FiO_2配型ARDS和顺应性配型ARDS(p <； 0.001)中，静脉混合液与无充气组织显著相关，而在新冠肺炎ARDS中无相关性(p = 0.75)，提示低氧血症不仅与无充气组织有关。PEEP从5cmH2O增加到15cmH2O，所有组的氧合均得到改善。然而，尽管PaO2/FiO2匹配的ARDS患者的肺力学和死腔得到改善，表明招募是主要机制，但新冠肺炎和顺应性匹配的ARDS患者的肺力学和死腔改善不变或恶化，表明招募潜力和/或血流重新分配较低。新冠肺炎-ARDS是ARDS的一个子集，总体特征是给定的PaO2/FiO2的顺应性和肺气量更高，至少在我们研究的时间范围内是这样。本文的在线版本(10.1007/s0013402-06281-2)包含补充材料，可供授权用户使用。
To investigate whether COVID-19-ARDS differs from all-cause ARDS. 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. 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. 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. The online version of this article (10.1007/s00134-020-06281-2) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
3.7
作者：
Ladakis, C;Myrianthefs, P;Baltopoulos, G
通讯作者：
Baltopoulos, G
DOI：
10.1016/s2213-2600(20)30370-2
发表时间：
2020-12
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Grasselli G;Tonetti T;Protti A;Langer T;Girardis M;Bellani G;Laffey J;Carrafiello G;Carsana L;Rizzuto C;Zanella A;Scaravilli V;Pizzilli G;Grieco DL;Di Meglio L;de Pascale G;Lanza E;Monteduro F;Zompatori M;Filippini C;Locatelli F;Cecconi M;Fumagalli R;Nava S;Vincent JL;Antonelli M;Slutsky AS;Pesenti A;Ranieri VM;collaborators
通讯作者：
collaborators
DOI：
10.1164/rccm.202004-1412oc
发表时间：
2020-09-01
影响因子：
24.7
作者：
Patel, Brijesh, V;Arachchillage, Deepa J.;Desai, Sujal R.
通讯作者：
Desai, Sujal R.
影响因子：
38.9
作者：
Ferrando, Carlos;Suarez-Sipmann, Fernando;Villar, Jesus
通讯作者：
Villar, Jesus
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny