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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2020

Open Access 01-12-2020 | Acute Respiratory Distress-Syndrome | ORIGINAL

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study

Authors: Davide Chiumello, Mattia Busana, Silvia Coppola, Federica Romitti, Paolo Formenti, Matteo Bonifazi, Tommaso Pozzi, Maria Michela Palumbo, Massimo Cressoni, Peter Herrmann, Konrad Meissner, Michael Quintel, Luigi Camporota, John J. Marini, Luciano Gattinoni

Published in: Intensive Care Medicine | Issue 12/2020

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Abstract

Purpose

To investigate whether COVID-19-ARDS differs from all-cause ARDS.

Methods

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.

Results

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.

Conclusions

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.
Appendix
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Metadata
Title
Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study
Authors
Davide Chiumello
Mattia Busana
Silvia Coppola
Federica Romitti
Paolo Formenti
Matteo Bonifazi
Tommaso Pozzi
Maria Michela Palumbo
Massimo Cressoni
Peter Herrmann
Konrad Meissner
Michael Quintel
Luigi Camporota
John J. Marini
Luciano Gattinoni
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 12/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-06281-2

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