Quantitative Computed Tomography and Response to Pronation in COVID-19 ARDS.
BACKGROUND: The use of prone position (PP) has been widespread during the COVID-19 pandemic. Whereas it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association betw...
| Publicado en: | Respiratory Care Vol. 69; no. 11; pp. 1380 - 1392 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Nov2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=180579725&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 180579725 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Nov2024 vid: 69 iid: 11 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 180579725 180579725 180579725 10.4187/respcare.11625 180579725 ppf: 1380 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Quantitative Computed Tomography and Response to Pronation in COVID-19 ARDS. aug: au: Zadek, Francesco Berta, Luca Zorzi, Giulia Ubiali, Stefania Bonaiti, Amos Tundo, Giulia Brunoni, Beatrice Marrazzo, Francesco Giudici, Riccardo Rossi, Anna Rizzetto, Francesco Bernasconi, Davide Paolo Vanzulli, Angelo Colombo, Paola Enrica Fumagalli, Roberto Torresin, Alberto Langer, Thomas sug: subj: Tomography, X-Ray Computed Methods Prone Position Patient Positioning COVID-19 Complications Respiratory Distress Syndrome, Acute Human Male Female Middle Age Aged Ventilator Patients Retrospective Design Record Review Nonexperimental Studies Blood Gas Analysis Pulmonary Gas Exchange T-Tests Mann-Whitney U Test Analysis of Variance Kruskal-Wallis Test Chi Square Test Fisher's Exact Test Linear Regression Descriptive Statistics Italy Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: The use of prone position (PP) has been widespread during the COVID-19 pandemic. Whereas it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative computed tomography (CT) scan results and gas exchange response to PP in invasively ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline quantitative CT results between subjects responding to PP in terms of oxygenation or CO2 clearance and those who did not. METHODS: This was a single-center, retrospective observational study including critically ill, invasively ventilated subjects with COVID-19-related ARDS admitted to the ICUs of Niguarda Hospital between March 2020-November 2021. Blood gas samples were collected before and after PP. Subjects in whom the PaO2 /FIO2 increase was ≥ 20 mm Hg after PP were defined as oxygen responders. CO2 responders were defined when the ventilatory ratio (VR) decreased during PP. Automated quantitative CT analyses were performed to obtain tissue mass and density of the lungs. RESULTS: One hundred twenty-five subjects were enrolled, of which 116 (93%) were O2 responders and 51 (41%) CO2 responders. No difference in quantitative CT characteristics and oxygen were observed between responders and non-responders (tissue mass 1,532 ± 396 g vs 1,654 ± 304 g, P = .28; density -544 ± 109 HU vs -562 ± 58 HU P = .42). Similar findings were observed when dividing the population according to CO2 response (tissue mass 1,551 ± 412 g vs 1,534 ± 377 g, P = .89; density -545 ± 123 HU vs -546 ± 94 HU, P = .99). CONCLUSIONS: Most subjects with COVID-19-related ARDS improved their oxygenation at the first pronation cycle. The study suggests that baseline quantitative CT scan data were not associated with the response to PP in oxygenation or CO2 in mechanically ventilated subjects with COVID-19-related ARDS. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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