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Scaramuzzo G, Karbing DS, Fogagnolo A, Mauri T, Spinelli E, Mari M, Turrini C, Montanaro F, Volta CA, Rees SE, Spadaro S. Heterogeneity of Ventilation/Perfusion Mismatch at Different Levels of PEEP and in Mechanical Phenotypes of COVID-19 ARDS. Respir Care 2022; 68:respcare.10242. [PMID: 36347564 PMCID: PMC9994283 DOI: 10.4187/respcare.10242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND COVID-19-related ARDS is characterized by severe hypoxemia with initially preserved lung compliance and impaired ventilation/perfusion (V̇/Q̇) matching. PEEP can increase end-expiratory lung volume, but its effect on V̇/Q̇ mismatch in COVID-19-related ARDS is not clear. METHODS We enrolled intubated and mechanically ventilated subjects with COVID-19 ARDS and used the automatic lung parameter estimator (ALPE) to measure V̇/Q̇. Respiratory mechanics measurements, shunt, and V̇/Q̇ mismatch (low V̇/Q̇ and high V̇/Q̇) were collected at 3 PEEP levels (clinical PEEP = intermediate PEEP, low PEEP [clinical - 50%], and high PEEP [clinical + 50%]). A mixed-effect model was used to evaluate the impact of PEEP on V̇/Q̇. We also investigated if PEEP might have a different effect on V̇/Q̇ mismatch in 2 different respiratory mechanics phenotypes, that is, high elastance/low compliance (phenotype H) and low elastance/high compliance (phenotype L). RESULTS Seventeen subjects with COVID-related ARDS age 66 [60-71] y with a PaO2 /FIO2 of 141 ± 74 mm Hg were studied at low PEEP = 5.6 ± 2.2 cm H2O, intermediate PEEP = 10.6 ± 3.8 cm H2O, and high PEEP = 15 ± 5 cm H2O. Shunt, low V̇/Q̇, high V̇/Q̇, and alveolar dead space were not significantly influenced, on average, by PEEP. Respiratory system compliance decreased significantly when increasing PEEP without significant variation of PaO2 /FIO2 (P = .26). In the 2 phenotypes, PEEP had opposite effects on shunt, with a decrease in the phenotype L and an increase in phenotype H (P = .048). CONCLUSIONS In subjects with COVID-related ARDS placed on invasive mechanical ventilation for > 48 h, PEEP had a heterogeneous effect on V̇/Q̇ mismatch and, on average, higher levels were not able to reduce shunt. The subject's compliance could influence the effect of PEEP on V̇/Q̇ mismatch since an increased shunt was observed in subjects with lower compliance, whereas the opposite occurred in those with higher compliance.
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Affiliation(s)
- Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy; and Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Dan Stieper Karbing
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Alberto Fogagnolo
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Institute for Treatment and Research, Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elena Spinelli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matilde Mari
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Cecilia Turrini
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Federica Montanaro
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy; and Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Stephen Edward Rees
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy; and Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy.
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2
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More questions than answers for the use of inhaled nitric oxide in COVID-19. Nitric Oxide 2022; 124:39-48. [PMID: 35526702 PMCID: PMC9072755 DOI: 10.1016/j.niox.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Abstract
Inhaled nitric oxide (iNO) is a potent vasodilator approved for use in term and near-term neonates, but with broad off-label use in settings including acute respiratory distress syndrome (ARDS). As an inhaled therapy, iNO reaches well ventilated portions of the lung and selectively vasodilates the pulmonary vascular bed, with little systemic effect due to its rapid inactivation in the bloodstream. iNO is well documented to improve oxygenation in a variety of pathological conditions, but in ARDS, these transient improvements in oxygenation have not translated into meaningful clinical outcomes. In coronavirus disease 2019 (COVID-19) related ARDS, iNO has been proposed as a potential treatment due to a variety of mechanisms, including its vasodilatory effect, antiviral properties, as well as anti-thrombotic and anti-inflammatory actions. Presently however, no randomized controlled data are available evaluating iNO in COVID-19, and published data are largely derived from retrospective and cohort studies. It is therefore important to interpret these limited findings with caution, as many questions remain around factors such as patient selection, optimal dosing, timing of administration, duration of administration, and delivery method. Each of these factors may influence whether iNO is indeed an efficacious therapy - or not - in this context. As such, until randomized controlled trial data are available, use of iNO in the treatment of patients with COVID-19 related ARDS should be considered on an individual basis with sound clinical judgement from the attending physician.
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Onorati I, Bonnet N, Radu DM, Freynet O, Guiraudet P, Kambouchner M, Uzunhan Y, Zogheib E, Martinod E. Case Report: Laryngotracheal Post-Intubation/Tracheostomy Stenosis in COVID-19 Patients. Front Surg 2022; 9:874077. [PMID: 35548193 PMCID: PMC9082634 DOI: 10.3389/fsurg.2022.874077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The novel Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has spread rapidly to become a major global public health emergency since March 2020. Laryngotracheal stenosis (LTS) has been observed more frequently since the onset of the COVID-19 pandemic. Methods All patients referred to our 24/7 Airway Diseases Center for laryngotracheal post-intubation/tracheostomy stenosis from May 2020 to May 2021were evaluated retrospectively. Patient data on comorbidities, diagnosis, type of procedures, lengths of ICU stay and invasive mechanical ventilation, medical treatment, and the severity of illness were recorded. Results This case series included nine patients (five women and four men), with a mean age of 52.9 years, most with a BMI >30, all with a severe illness revealed by the Simplified Acute Physiology Score (SAPS) II >31. From May 2020 to May 2021, 21 procedures were performed on seven patients, consisting of bronchoscopic rigid interventions, T-tube Montgomery tracheostomy, and one cricotracheal resection with end-to-end anastomosis. Histologic examination of tracheal biopsies showed an inflammatory state of the airway mucosa. Two patients only had medical therapy. Discussion and Conclusions Pneumonia caused by SARSCoV-2 can lead to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. The time of intubation, the drugs used, the prone position, comorbidities (diabetes, obesity), and the inflammatory state of the upper airways linked to the viral infection, predispose to an increased tendency to stenosis and its recurrence. A conservative approach with medical and endoscopic treatment should be preferred in case of persistence of local airways inflammation. Further studies with a larger sample of patients will help to a better understanding of the disease, reduce the prevalence, and improve its treatment.
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Affiliation(s)
- Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- *Correspondence: Ilaria Onorati
| | - Nicolas Bonnet
- Department of Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Dana Mihaela Radu
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Olivia Freynet
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Patrice Guiraudet
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Yurdagul Uzunhan
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Elie Zogheib
- Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
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4
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Serbanescu-Kele Apor de Zalán CM, Foudraine NA, Noble JLL. Inhaled iloprost can improve oxygenation and shunt fraction in severe COVID-19. Acute Crit Care 2022; 37:127-130. [PMID: 35279981 PMCID: PMC8918720 DOI: 10.4266/acc.2021.01263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
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5
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Cumpstey AF, Clark AD, Santolini J, Jackson AA, Feelisch M. COVID-19: A Redox Disease-What a Stress Pandemic Can Teach Us About Resilience and What We May Learn from the Reactive Species Interactome About Its Treatment. Antioxid Redox Signal 2021; 35:1226-1268. [PMID: 33985343 DOI: 10.1089/ars.2021.0017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Significance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), affects every aspect of human life by challenging bodily, socioeconomic, and political systems at unprecedented levels. As vaccines become available, their distribution, safety, and efficacy against emerging variants remain uncertain, and specific treatments are lacking. Recent Advances: Initially affecting the lungs, COVID-19 is a complex multisystems disease that disturbs the whole-body redox balance and can be long-lasting (Long-COVID). Numerous risk factors have been identified, but the reasons for variations in susceptibility to infection, disease severity, and outcome are poorly understood. The reactive species interactome (RSI) was recently introduced as a framework to conceptualize how cells and whole organisms sense, integrate, and accommodate stress. Critical Issues: We here consider COVID-19 as a redox disease, offering a holistic perspective of its effects on the human body, considering the vulnerability of complex interconnected systems with multiorgan/multilevel interdependencies. Host/viral glycan interactions underpin SARS-CoV-2's extraordinary efficiency in gaining cellular access, crossing the epithelial/endothelial barrier to spread along the vascular/lymphatic endothelium, and evading antiviral/antioxidant defences. An inflammation-driven "oxidative storm" alters the redox landscape, eliciting epithelial, endothelial, mitochondrial, metabolic, and immune dysfunction, and coagulopathy. Concomitantly reduced nitric oxide availability renders the sulfur-based redox circuitry vulnerable to oxidation, with eventual catastrophic failure in redox communication/regulation. Host nutrient limitations are crucial determinants of resilience at the individual and population level. Future Directions: While inflicting considerable damage to health and well-being, COVID-19 may provide the ultimate testing ground to improve the diagnosis and treatment of redox-related stress diseases. "Redox phenotyping" of patients to characterize whole-body RSI status as the disease progresses may inform new therapeutic approaches to regain redox balance, reduce mortality in COVID-19 and other redox diseases, and provide opportunities to tackle Long-COVID. Antioxid. Redox Signal. 35, 1226-1268.
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Affiliation(s)
- Andrew F Cumpstey
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anna D Clark
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), Biochemistry, Biophysics and Structural Biology, CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, Gif-sur-Yvette, France
| | - Alan A Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Martin Feelisch
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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6
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Scaramuzzo G, Gamberini L, Tonetti T, Zani G, Ottaviani I, Mazzoli CA, Capozzi C, Giampalma E, Bacchi Reggiani ML, Bertellini E, Castelli A, Cavalli I, Colombo D, Crimaldi F, Damiani F, Fusari M, Gamberini E, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Nardi G, Papa R, Potalivo A, Russo E, Taddei S, Consales G, Cappellini I, Ranieri VM, Volta CA, Guerin C, Spadaro S. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study. Ann Intensive Care 2021; 11:63. [PMID: 33900484 PMCID: PMC8072095 DOI: 10.1186/s13613-021-00853-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/10/2021] [Indexed: 01/02/2023] Open
Abstract
Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (< median PaO2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00853-1.
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Affiliation(s)
- Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara & Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8 Cona, 44121, Ferrara, Italy
| | - Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Irene Ottaviani
- Department of Translational Medicine and for Romagna, University of Ferrara & Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8 Cona, 44121, Ferrara, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Chiara Capozzi
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Maria Letizia Bacchi Reggiani
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Statistical Service, Alma Mater University, S. Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Andrea Castelli
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Cavalli
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department, SS. Trinità Hospital, ASL, Novara, Italy.,Translational Medicine Department, Eastern Piedmont University, Novara, Italy
| | | | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy, Imola Hospital, Imola, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Emiliano Gamberini
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Anesthesia and Intensive Care Unit of Transplant, Department of Organ Failures and Transplants, Azienda Ospedaliero-Universitaria Di Bologna (IRCCS), Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Bologna, Italy
| | - Guglielmo Consales
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara & Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8 Cona, 44121, Ferrara, Italy
| | - Claude Guerin
- Médecine Intensive-Réanimation Groupement Hospitalier Edouard Herriot, Université de Lyon Faculté de Médecine Lyon-Est, Lyon, Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara & Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8 Cona, 44121, Ferrara, Italy.
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7
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Garfield B, McFadyen C, Briar C, Bleakley C, Vlachou A, Baldwin M, Lees N, Price S, Ledot S, McCabe C, Wort SJ, Patel BV, Price LC. Potential for personalised application of inhaled nitric oxide in COVID-19 pneumonia. Br J Anaesth 2021; 126:e72-e75. [PMID: 33288208 PMCID: PMC7666572 DOI: 10.1016/j.bja.2020.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Benjamin Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Charlotte Briar
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | | | | | - Melissa Baldwin
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Nick Lees
- Adult Intensive Care Unit, Harefield Hospital, Harefield, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - S John Wort
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - Brijesh V Patel
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; Anaesthetics, Pain Medicine and Intensive Care, Surgery and Cancer, Imperial College London, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK.
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8
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Santamarina MG, Boisier Riscal D, Beddings I, Contreras R, Baque M, Volpacchio M, Martinez Lomakin F. COVID-19: What Iodine Maps From Perfusion CT can reveal-A Prospective Cohort Study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:619. [PMID: 33087155 PMCID: PMC7576979 DOI: 10.1186/s13054-020-03333-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Subtraction CT angiography (sCTA) is a technique used to evaluate pulmonary perfusion based on iodine distribution maps. The aim of this study is to assess lung perfusion changes with sCTA seen in patients with COVID-19 pneumonia and correlate them with clinical outcomes. MATERIAL AND METHODS A prospective cohort study was carried out with 45 RT-PCR-confirmed COVID-19 patients that required hospitalization at three different hospitals, between April and May 2020. In all cases, a basic clinical and demographic profile was obtained. Lung perfusion was assessed using sCTA. Evaluated imaging features included: Pattern predominance of injured lung parenchyma in both lungs (ground-glass opacities, consolidation and mixed pattern) and anatomical extension; predominant type of perfusion abnormality (increased perfusion or hypoperfusion), perfusion abnormality distribution (focal or diffuse), extension of perfusion abnormalities (mild, moderate and severe involvement); presence of vascular dilatation and vascular tortuosity. All participants were followed-up until hospital discharge searching for the development of any of the study endpoints. These endpoints included intensive-care unit (ICU) admission, initiation of invasive mechanical ventilation (IMV) and death. RESULTS Forty-one patients (55.2 ± 16.5 years, 22 men) with RT-PCR-confirmed SARS-CoV-2 infection and an interpretable iodine map were included. Patients with perfusion anomalies on sCTA in morphologically normal lung parenchyma showed lower Pa/Fi values (294 ± 111.3 vs. 397 ± 37.7, p = 0.035), and higher D-dimer levels (1156 ± 1018 vs. 378 ± 60.2, p < 0.01). The main common patterns seen in lung CT scans were ground-glass opacities, mixed pattern with predominant ground-glass opacities and mixed pattern with predominant consolidation in 56.1%, 24.4% and 19.5% respectively. Perfusion abnormalities were common (36 patients, 87.8%), mainly hypoperfusion in areas of apparently healthy lung. Patients with severe hypoperfusion in areas of apparently healthy lung parenchyma had an increased probability of being admitted to ICU and to initiate IMV (HR of 11.9 (95% CI 1.55-91.9) and HR 7.8 (95% CI 1.05-61.1), respectively). CONCLUSION Perfusion abnormalities evidenced in iodine maps obtained by sCTA are associated with increased admission to ICU and initiation of IMV in COVID-19 patients.
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Affiliation(s)
- Mario G Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile. .,Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile.
| | | | | | - Roberto Contreras
- Intensive Care Unit, Hospital San Martin de Quillota, Quillota, Chile
| | - Martiniano Baque
- Intensive Care Unit, Hospital IESS Los Ceibos, Guayaquil, Ecuador
| | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
| | - Felipe Martinez Lomakin
- Intensive Care Unit, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Viña del Mar, Escuela de Medicina, Facultad de Medicina Viña del Mar, Universidad Andres Bello, Valparaiso, Chile
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9
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Longobardo A, Montanari C, Shulman R, Benhalim S, Singer M, Arulkumaran N. Inhaled nitric oxide minimally improves oxygenation in COVID-19 related acute respiratory distress syndrome. Br J Anaesth 2020; 126:e44-e46. [PMID: 33138964 PMCID: PMC7556790 DOI: 10.1016/j.bja.2020.10.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Alessia Longobardo
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Cecilia Montanari
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Robert Shulman
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Suzanne Benhalim
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
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