COVID-19 和典型 ARDS 的生理学和定量 CT 扫描特征：一项匹配队列研究。
Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
机构信息
Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Milan, Italy.
Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Robert-Koch Straße 40, Göttingen, Germany.
出版信息
Intensive Care Med. 2020 Dec;46(12):2187-2196. doi: 10.1007/s00134-020-06281-2. Epub 2020 Oct 21.
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 PaO/FiO or for compliance of the respiratory system. Gas exchange, hemodynamics and respiratory mechanics were recorded at 5 and 15 cmHO PEEP. CT scan variables were measured at 5 cmHO PEEP.
RESULTS
Anthropometric characteristics were similar in COVID-19-ARDS, PaO/FiO-matched-ARDS and Compliance-matched-ARDS. The PaO/FiO-matched-ARDS and COVID-19-ARDS populations (both with PaO/FiO 106 ± 59 mmHg) had different respiratory system compliances (Crs) (39 ± 11 vs 49.9 ± 15.4 ml/cmHO, p = 0.03). The Compliance-matched-ARDS and COVID-19-ARDS had similar Crs (50.1 ± 15.7 and 49.9 ± 15.4 ml/cmHO, respectively) but significantly lower PaO/FiO 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 (PaO/FiO-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 PaO/FiO-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 cmHO improved oxygenation in all groups. However, while lung mechanics and dead space improved in PaO/FiO-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 PaO/FiO, at least when considered within the timeframe of our study.
目的
研究 COVID-19 相关急性呼吸窘迫综合征（ARDS）与其他病因所致 ARDS 是否存在差异。
方法
连续纳入 32 例接受机械通气的 COVID-19 相关 ARDS 患者，并与 2 组历史 ARDS 亚组进行 1:1 配对比较，匹配条件分别为氧合指数（PaO/FiO）或呼吸系统顺应性。分别于 5 cmH2O 和 15 cmH2O 呼气末正压（PEEP）水平下记录患者的气体交换、血流动力学和呼吸力学指标，并于 5 cmH2O PEEP 水平下测量 CT 扫描变量。
结果
COVID-19 相关 ARDS 患者、PaO/FiO 匹配 ARDS 患者和顺应性匹配 ARDS 患者的人体测量特征相似。PaO/FiO 匹配 ARDS 患者和 COVID-19 相关 ARDS 患者的 PaO/FiO 相似（均为 106 ± 59 mmHg），但呼吸系统顺应性不同（39 ± 11 比 49.9 ± 15.4 ml/cmH2O，p = 0.03）。顺应性匹配 ARDS 患者和 COVID-19 相关 ARDS 患者的呼吸系统顺应性相似（分别为 50.1 ± 15.7 和 49.9 ± 15.4 ml/cmH2O），但在相同的呼吸系统顺应性下 PaO/FiO 更低（160 ± 62 比 106.5 ± 59.6 mmHg，p < 0.001）。3 组患者的肺重量相似，但 COVID-19 相关 ARDS 患者的肺气体容积显著更高（PaO/FiO 匹配 ARDS 患者为 930 ± 644 ml，COVID-19 相关 ARDS 患者为 1670 ± 791 ml，顺应性匹配 ARDS 患者为 1301 ± 627 ml，p < 0.05）。静脉混合血中的氧含量与 PaO/FiO 匹配 ARDS 患者和顺应性匹配 ARDS 患者的非通气组织量显著相关（p < 0.001），但与 COVID-19 相关 ARDS 患者无关（p = 0.75），提示低氧血症不仅与非通气组织量有关。将 PEEP 从 5 cmH2O 增加到 15 cmH2O 可改善所有患者的氧合。然而，尽管 PaO/FiO 匹配 ARDS 患者的肺力学和死腔量改善，提示存在复张，但 COVID-19 相关 ARDS 患者和顺应性匹配 ARDS 患者的肺力学和死腔量无变化或恶化，提示其复张潜力较低和/或血流重新分布。
结论
COVID-19 相关 ARDS 是 ARDS 的一个亚组，其特征为在给定的 PaO/FiO 下，顺应性更高，肺气体容积更大，至少在我们的研究时间范围内是如此。
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