Role of total lung stress on the progression of early COVID-19 pneumonia

Purpose We investigated if the stress applied to the lung during non-invasive respiratory support may contribute to the coronavirus disease 2019 (COVID-19) progression. Methods Single-center, prospective, cohort study of 140 consecutive COVID-19 pneumonia patients treated in high-dependency unit wit...

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Bibliographic Details
Published in:Intensive care medicine 2021-10, Vol.47 (10), p.1130-1139
Main Authors: Coppola, Silvia, Chiumello, Davide, Busana, Mattia, Giola, Emanuele, Palermo, Paola, Pozzi, Tommaso, Steinberg, Irene, Roli, Stefano, Romitti, Federica, Lazzari, Stefano, Gattarello, Simone, Palumbo, Michela, Herrmann, Peter, Saager, Leif, Quintel, Michael, Meissner, Konrad, Camporota, Luigi, Marini, John J., Centanni, Stefano, Gattinoni, Luciano
Format: Article
Language:English
Subjects:
Aeration
Anesthesiology
Bacterial pneumonia
Care and treatment
Cohort Studies
Computed tomography
Continuous positive airway pressure
Coronavirus
Coronaviruses
COVID-19
Critical Care Medicine
CT imaging
Development and progression
Emergency Medicine
Esophagus
Humans
Hypoxemia
Intensive
Intensive care
Lung - diagnostic imaging
Lungs
Mechanical ventilation
Medicine
Medicine & Public Health
Original
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Pneumonia
Pressure
Prospective Studies
Regression analysis
SARS-CoV-2
Stress
Subgroups
Viral diseases
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Summary:Purpose We investigated if the stress applied to the lung during non-invasive respiratory support may contribute to the coronavirus disease 2019 (COVID-19) progression. Methods Single-center, prospective, cohort study of 140 consecutive COVID-19 pneumonia patients treated in high-dependency unit with continuous positive airway pressure ( n  = 131) or non-invasive ventilation ( n  = 9). We measured quantitative lung computed tomography, esophageal pressure swings and total lung stress. Results Patients were divided in five subgroups based on their baseline PaO 2 /FiO 2 (day 1): non-CARDS (median PaO 2 /FiO 2 361 mmHg, IQR [323–379]), mild (224 mmHg [211–249]), mild-moderate (173 mmHg [164–185]), moderate-severe (126 mmHg [114–138]) and severe (88 mmHg [86–99], p  
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-021-06519-7