Correlation of Respiratory Physiologic Parameters in Mechanically Ventilated Coronavirus Disease 2019 Patients

Saha, Biplab K.; Ghalib, Sana; Chieng, Hau; Pezzano, Chad; Lydon, Darren; Feustel, Paul J.; Smith, Thomas C.; Chopra, Amit

doi:10.1097/cce.0000000000000328

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Some authors have suggested that prolonged coughing may be contributory (88). Although static lung compliance in acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia may be initially high, patients with advanced ARDS lasting more than a week often have low lung compliance, similar to ARDS from other etiologies (89,90). Low lung compliance and prolonged duration of mechanical ventilation in non-COVID-19 ARDS have been associated with a higher incidence of pneumothorax (91,92).…”

Section: Pneumothorax In Covid-19mentioning

confidence: 99%

Pleural abnormalities in COVID-19: a narrative review

Saha

Chong²,

Austin³

et al. 2021

J Thorac Dis

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Objective: This narrative review aims to provide a detailed overview of pleural abnormalities in patients with coronavirus disease 19 or COVID-19.Background: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is a novel beta coronavirus responsible for COVID-19. Although pulmonary parenchymal and vascular changes associated with COVID-19 are well established, pleural space abnormalities have not been the primary focus of investigations.Methods: Narrative overview of the medical literature regarding pleural space abnormalities in COVID-19. The appropriate manuscripts were identified by searching electronic medical databases and by hand searching the bibliography of the identified papers. Pleural abnormalities on transverse and ultrasound imaging are discussed. The incidence, clinical features, pathophysiology, and fluid characteristics of pleural effusion are reviewed. Studies reporting pneumothorax and pneumomediastinum are examined to evaluate for pathogenesis and prognosis. A brief comparative analysis of pleural abnormalities among patients with COVID-19, severe acute respiratory syndrome (SARS), and Middle Eastern respiratory syndrome (MERS) has been provided.Conclusions: Radiologic pleural abnormalities are common in COVID-19, but the incidence of pleural effusion appears to be low. Pneumothorax is rare and does not independently predispose the patient to worse outcomes. SARS-CoV-2 infects the pleural space; however, whether the pleural fluid can propagate the infection is unclear.

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Section: Pneumothorax In Covid-19mentioning

confidence: 99%

Pleural abnormalities in COVID-19: a narrative review

Saha

Chong²,

Austin³

et al. 2021

J Thorac Dis

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“…These findings suggest that disturbed pulmonary perfusion, resulting in a ventilation-perfusion mismatch, caused hypoxemia in these patients. Nevertheless, all patients had a reduced static compliance, possibly leading to disturbed minute ventilation or increased dead space fraction as well [ 25 ]. Patients in PEEP lower group had a longer time between onset of symptoms and intubation.…”

Section: Discussionmentioning

confidence: 99%

PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS

et al. 2022

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Rationale It is unknown how to titrate positive end-expiratory pressure (PEEP) in patients with COVID-19-related acute respiratory distress syndrome (ARDS). Guidelines recommend the one-size-fits-all PEEP-FiO2 table. In this retrospective cohort study, an electrical impedance tomography (EIT)-guided PEEP trial was used to titrate PEEP. Objectives To compare baseline PEEP according to the high PEEP-FiO2 table and personalized PEEP following an EIT-guided PEEP trial. Methods We performed an EIT-guided decremental PEEP trial in patients with moderate-to-severe COVID-19-related ARDS upon intensive care unit admission. PEEP was set at the lowest PEEP above the intersection of curves representing relative alveolar overdistention and collapse. Baseline PEEP was compared with PEEP set according to EIT. We identified patients in whom the EIT-guided PEEP trial resulted in a decrease or increase in PEEP of ≥ 2 cmH2O. Measurements and main results We performed a PEEP trial in 75 patients. In 23 (31%) patients, PEEP was decreased ≥ 2 cmH2O, and in 24 (32%) patients, PEEP was increased ≥ 2 cmH2O. Patients in whom PEEP was decreased had improved respiratory mechanics and more overdistention in the non-dependent lung region at higher PEEP levels. These patients also had a lower BMI, longer time between onset of symptoms and intubation, and higher incidence of pulmonary embolism. Oxygenation improved in patients in whom PEEP was increased. Conclusions An EIT-guided PEEP trial resulted in a relevant change in PEEP in 63% of patients. These results support the hypothesis that PEEP should be personalized in patients with ARDS.

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“…Hypoxemia is associated with a huge increase in intrapulmonary shunt (measuring the percentage of blood that does not oxygenate in the lungs) due to alveolar fluid filling/consolidations. In fact, the pulmonary shunt fraction is in physiological conditions below 5% 7 , whereas it reaches values up to in patients with ongoing COVID-19 infection 8 , 9 . Endothelial damage with diffuse micro-thrombosis has been widely described in histological studies in COVID-19 pneumonia patients and is associated with an increase in dead space in lungs and thus in non-oxygenated blood 10 .…”

Section: Introductionmentioning

confidence: 92%

A mathematical model to assess the effects of COVID-19 on the cardiocirculatory system

Tonini,

Vergara,

Regazzoni

et al. 2024

Sci Rep

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Impaired cardiac function has been described as a frequent complication of COVID-19-related pneumonia. To investigate possible underlying mechanisms, we represented the cardiovascular system by means of a lumped-parameter 0D mathematical model. The model was calibrated using clinical data, recorded in 58 patients hospitalized for COVID-19-related pneumonia, to make it patient-specific and to compute model outputs of clinical interest related to the cardiocirculatory system. We assessed, for each patient with a successful calibration, the statistical reliability of model outputs estimating the uncertainty intervals. Then, we performed a statistical analysis to compare healthy ranges and mean values (over patients) of reliable model outputs to determine which were significantly altered in COVID-19-related pneumonia. Our results showed significant increases in right ventricular systolic pressure, diastolic and mean pulmonary arterial pressure, and capillary wedge pressure. Instead, physical quantities related to the systemic circulation were not significantly altered. Remarkably, statistical analyses made on raw clinical data, without the support of a mathematical model, were unable to detect the effects of COVID-19-related pneumonia in pulmonary circulation, thus suggesting that the use of a calibrated 0D mathematical model to describe the cardiocirculatory system is an effective tool to investigate the impairments of the cardiocirculatory system associated with COVID-19.

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Correlation of Respiratory Physiologic Parameters in Mechanically Ventilated Coronavirus Disease 2019 Patients

Cited by 4 publications

References 10 publications

Pleural abnormalities in COVID-19: a narrative review

Pleural abnormalities in COVID-19: a narrative review

PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS

A mathematical model to assess the effects of COVID-19 on the cardiocirculatory system

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