학술논문
Pulmonary pathophysiology development of COVID-19 assessed by serial Electrical Impedance Tomography in the MaastrICCht cohort.
Document Type
Article
Author
Heines, Serge J. H.; van Bussel, Bas C. T.; Jong, Melanie J. Acampo-de; Bennis, Frank C.; van Gassel, Rob J. J.; Groven, Rald V. M.; Heijnen, Nanon F. L.; Hermans, Ben J. M.; Hounjet, René; van Koll, Johan; Mulder, Mark M. G.; van de Poll, Marcel C. G.; van Rosmalen, Frank; Segers, Ruud; Steyns, Sander; Strauch, Ulrich; Tas, Jeanette; van der Horst, Iwan C. C.; van Kuijk, Sander M. J.; Bergmans, Dennis C. J. J.
Source
Subject
*ELECTRICAL impedance tomography
*POSITIVE end-expiratory pressure
*RESPIRATORY mechanics
*COVID-19
*PATHOLOGICAL physiology
*ARTIFICIAL respiration
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Language
ISSN
2045-2322
Abstract
Patients with SARS-CoV-2 infection present with different lung compliance and progression of disease differs. Measures of lung mechanics in SARS-CoV-2 patients may unravel different pathophysiologic mechanisms during mechanical ventilation. The objective of this prospective observational study is to describe whether Electrical Impedance Tomography (EIT) guided positive end-expiratory pressure (PEEP) levels unravel changes in EIT-derived parameters over time and whether the changes differ between survivors and non-survivors. Serial EIT-measurements of alveolar overdistension, collapse, and compliance change in ventilated SARS-CoV-2 patients were analysed. In 80 out of 94 patients, we took 283 EIT measurements (93 from day 1–3 after intubation, 66 from day 4–6, and 124 from day 7 and beyond). Fifty-one patients (64%) survived the ICU. At admission mean PaO2/FiO2-ratio was 184.3 (SD 61.4) vs. 151.3 (SD 54.4) mmHg, (p = 0.017) and PEEP was 11.8 (SD 2.8) cmH2O vs. 11.3 (SD 3.4) cmH2O, (p = 0.475), for ICU survivors and non-survivors. At day 1–3, compliance was ~ 55 mL/cmH2O vs. ~ 45 mL/cmH2O in survivors vs. non-survivors. The intersection of overdistension and collapse curves appeared similar at a PEEP of ~ 12–13 cmH2O. At day 4–6 compliance changed to ~ 50 mL/cmH2O vs. ~ 38 mL/cmH2O. At day 7 and beyond, compliance was ~ 38 mL/cmH2O with the intersection at a PEEP of ~ 9 cmH2O vs. ~ 25 mL/cmH2O with overdistension intersecting at collapse curves at a PEEP of ~ 7 cmH2O. Surviving SARS-CoV-2 patients show more favourable EIT-derived parameters and a higher compliance compared to non-survivors over time. This knowledge is valuable for discovering the different groups. [ABSTRACT FROM AUTHOR]