Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study.
Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study.
复制标题
DOI：
10.1186/s13054-021-03610-9
复制
发表时间：
2021-06-21
期刊：
影响因子：
--
通讯作者：
Collaborators of the GECOVID Group
中科院分区：
文献类型：
--
作者：
Ball L;Robba C;Herrmann J;Gerard SE;Xin Y;Mandelli M;Battaglini D;Brunetti I;Minetti G;Seitun S;Bovio G;Vena A;Giacobbe DR;Bassetti M;Rocco PRM;Cereda M;Rizi RR;Castellan L;Patroniti N;Pelosi P;Collaborators of the GECOVID Group
重症COVID-19患者具有以灌注异常为特征的病理生理学肺特征。然而，迄今为止，尚无研究评估重度COVID-19肺炎患者肺气体和血容量分布的变化是否与气体交换受损的严重程度和呼吸支持的类型（无创与有创）相关。这是一项在北方意大利第一波大流行期间在三级保健医院进行的单中心、回顾性队列研究。使用双能量计算机断层扫描定量分析技术评估肺部气体和血液分布。在具有不同临床严重程度的重症COVID-19患者中评价了肺通气损失（通过正常通气肺组织的百分比反映）和气体：血容量不匹配的程度（非通气、灌注肺组织分流的百分比;通气、非灌注死腔;和非通气/非灌注区域），这些临床严重程度通过无创或有创呼吸支持的需要反映。纳入了2020年2月29日至5月30日期间入住重症监护室的35例患者。需要有创机械通气的患者与需要无创机械通气的患者相比，正常通气肺组织的百分比较低（中位数[四分位数间距] 33% [24-49%] vs. 63% [44-68%]，p < 0.001）;由于分流率较高（23% [15-32%] vs. 5% [2-16%]，p = 0.001）和非通气/非灌注区域较高（5% [3-10%] vs. 1% [0-2%]，p = 0.001），气体：血容量不匹配程度较高（43%[30-49%] vs. 25% [14-28%]，p = 0.001）。PaO 2/FiO 2比值与正常通气组织呈正相关（ρ = 0.730，p < 0.001），与气-血容量不匹配程度呈负相关（ρ =-0.633，p < 0.001）。在患有严重COVID-19肺炎的重症患者中，有创机械通气和氧合受损的需求与通气丧失和气体：血容量不匹配的程度相关。在线版本包含补充材料，可通过10.1186/s13054-021-03610-9获得。
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. 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. 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/FiO2 ratio correlated positively with normally aerated tissue (ρ = 0.730, p < 0.001) and negatively with the extent of gas-blood volume mismatch (ρ = − 0.633, p < 0.001). 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. The online version contains supplementary material available at 10.1186/s13054-021-03610-9.
登录
查看更多内容
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
影响因子：
10.9
作者：
Gerard, Sarah E.;Herrmann, Jacob;Reinhardt, Joseph M.
通讯作者：
Reinhardt, Joseph M.
DOI：
10.1164/rccm.201804-0692oc
发表时间：
2019-02-01
影响因子：
24.7
作者：
Sinha, Pratik;Calfee, Carolyn S.;Kallet, Richard H.
通讯作者：
Kallet, Richard H.
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny
影响因子：
3.5
作者：
Protti A;Iapichino GE;Milesi M;Melis V;Pugni P;Comini B;Cressoni M;Gattinoni L
通讯作者：
Gattinoni L