Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

Abstract

Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76–98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (n = 6) and deceased (n = 17). Immediately after prone ventilation, PaO2/FiO2 improved by 108% (p < 0.03) for the living and 150% (p < 3 × 10−4) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO2/FiO2.

Predicting Mechanical Ventilation and Mortality in COVID-19 Using Radiomics and Deep Learning on Chest Radiographs: A Multi-Institutional Study

“…In order to develop a clinical baseline model, we adopted a previously described CXR scoring system for COVID-19 patients [7]. Scoring of CXRs was performed by radiology residents (G.S., R.G., S.A., N.S., C.M., and J.P.).…”

“…Coronavirus disease 2019 (COVID- 19), an illness caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly across the world, with over 200 million cases internationally and over 35 million cases in the United States as of 5 August 2021 [1]. Advanced cases of the disease can progress to acute respiratory distress syndrome requiring mechanical ventilation [2][3][4][5][6][7]. Thus far, over 4.2 million people have died internationally [1].…”

“…The ability to identify patients that might progress to critical illness from initial clinical presentation can better guide clinical management strategies and improve patient outcomes [2][3][4]. Several studies have demonstrated that radiologic imaging may be useful in this regard [2,7,8].…”

“…Recent studies have qualitatively described the association of ground-glass opacities and lung consolidations with disease severity and progression on CXR and CT [2,[5][6][7]11,12]. Specifically, the presence of opacities in multiple lobes has been shown to predict severe illness, and several CXR scoring systems have been developed to assess disease severity based upon this premise [2,6,7].…”

“…Recent studies have qualitatively described the association of ground-glass opacities and lung consolidations with disease severity and progression on CXR and CT [2,[5][6][7]11,12]. Specifically, the presence of opacities in multiple lobes has been shown to predict severe illness, and several CXR scoring systems have been developed to assess disease severity based upon this premise [2,6,7]. Studies have also evaluated various clinical biomarkers and comorbidities as predictors of disease progression, and there is some evidence that imaging data might complement these models [4][5][6][13][14][15][16].…”