定量计算机断层扫描与 COVID-19 相关急性呼吸窘迫综合征旋前反应。

Quantitative Computed Tomography and Response to Pronation in COVID-19 ARDS.

机构信息

Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.

Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

出版信息

Respir Care. 2024 Oct 25;69(11):1380-1391. doi: 10.4187/respcare.11625.

DOI:10.4187/respcare.11625

PMID:38594036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11549634/

Abstract

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 CO 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 P /F increase was ≥ 20 mm Hg after PP were defined as oxygen responders. CO 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 O responders and 51 (41%) CO 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, = .28; density -544 ± 109 HU vs -562 ± 58 HU = .42). Similar findings were observed when dividing the population according to CO response (tissue mass 1,551 ± 412 g vs 1,534 ± 377 g, = .89; density -545 ± 123 HU vs -546 ± 94 HU, = .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 CO in mechanically ventilated subjects with COVID-19-related ARDS.

摘要

背景

在 COVID-19 大流行期间，俯卧位（PP）的使用已经广泛。虽然它已经证明了一些益处，包括改善氧合和肺通气，但影响气体交换对 PP 反应的因素仍不清楚。特别是，在接受有创通气的 COVID-19 急性呼吸窘迫综合征（ARDS）患者中，基线定量计算机断层扫描（CT）扫描结果与 PP 后气体交换反应之间的关联尚不清楚。本研究旨在比较在氧合或 CO 清除方面对 PP 有反应的患者与无反应的患者的基线定量 CT 结果。

方法

这是一项单中心、回顾性观察性研究，纳入了 2020 年 3 月至 2021 年 11 月期间在尼瓜达医院 ICU 接受有创通气的 COVID-19 相关 ARDS 危重症患者。在 PP 前后采集血气样本。将 PP 后 P/F 增加≥20mmHg 的患者定义为氧反应者。将 PP 期间通气比（VR）降低的患者定义为 CO 反应者。进行自动定量 CT 分析以获得肺组织质量和密度。

结果

共纳入 125 例患者，其中 116 例（93%）为氧反应者，51 例（41%）为 CO 反应者。在反应者和无反应者之间，定量 CT 特征和氧没有差异（组织质量 1532±396g 与 1654±304g， =.28；密度-544±109HU 与-562±58HU， =.42）。当根据 CO 反应对人群进行划分时，也观察到了类似的发现（组织质量 1551±412g 与 1534±377g， =.89；密度-545±123HU 与-546±94HU， =.99）。