A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography

Critical Care

Aleksandra Larina¹  Robert Frithiof¹  Miklos Lipcsey²  Gaetano Perchiazzi²  Mariangela Pellegrini²  Michael Hultström³  Monica Segelsjö⁴  Tomas Hansen⁴  Evangelos Mourtos⁴ 

[1] Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden;Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden;Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden;Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden;Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;

关键词: COVID-19;    SARS-CoV2;    ARDS;    Acute respiratory distress syndrome;    Mechanical ventilation;    Computed tomography;   

DOI  :  10.1186/s13054-021-03685-4

来源: Springer

【 摘 要 】

BackgroundTypical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.MethodsThis was a prospective study. For each CT, twenty images, evenly spaced along the cranio-caudal axis, were selected. For regional analysis, each CT image was divided into three concentric subpleural regions of interest and four quadrants. Hyper-, normally, hypo- and non-inflated lung compartments were defined. Nonparametric tests were used for hypothesis testing (α = 0.05). Spearman correlation test was used to detect correlations between lung compartments and clinical features.ResultsTwenty-three out of 111 recruited patients were eligible for further analysis. Five hundred-sixty CT images were analyzed. Lung injury, composed by hypo- and non-inflated areas, was significantly more represented in subpleural than in core lung regions. A secondary, centripetal spread of lung injury was associated with exposure to mechanical ventilation (p < 0.04), longer spontaneous breathing (more than 14 days, p < 0.05) and non-protective tidal volume (p < 0.04). Positive fluid balance (p < 0.01), high plasma D-dimers (p < 0.01) and ferritin (p < 0.04) were associated with increased lung injury.ConclusionsIn a cohort of COVID-19 patients with severe respiratory failure, a predominant subpleural distribution of lung injury is observed. Prolonged spontaneous breathing and high tidal volumes, both causes of patient self-induced lung injury, are associated to an extensive involvement of more central regions. Positive fluid balance, inflammation and thrombosis are associated with lung injury.Trial registration Study registered a priori the 20th of March, 2020. Clinical Trials ID NCT04316884.

【 授权许可】

CC BY