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

Coppola, Silvia; Chiumello, Davide; Busana, Mattia; Giola, Emanuele; Palermo, Paola; Pozzi, Tommaso; Steinberg, Irene; Roli, Stefano; Romitti, Federica; Lazzari, Stefano; Gattarello, Simone; Palumbo, Maria Michela; Herrmann, Peter; Saager, Leif; Quintel, Michael; Meissner, Konrad; Camporota, Luigi; Marini, John J.; Centanni, Stefano; Gattinoni, Luciano

doi:10.1007/s00134-021-06519-7

Cited by 51 publications

(88 citation statements)

References 45 publications

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“…In confirmation of this, in a previous work of Chiumello et al, a weak correlation between the venous admixture (cause of hypoxemia) and non-aerated tissue suggested that the major component of the venous admixture in COVID-19 pneumonia is the ventilationperfusion mismatch rather than the true right-to-left shunt due to nonventilated consolidated tissues (unlike what was previously observed in typical ARDS) [39,42,43,49,73,74].…”

Section: Discussionsupporting

confidence: 60%

“…First, quantification of lung volumes with lower total and well-aerated lung tissue in patients with disease progression than in patients discharged (as in our case series) turned out to be a key factor in setting some mechanical ventilation parameters [39,49,[54][55][56][57][58][59].…”

Section: Discussionmentioning

confidence: 80%

“…with different gas/tissue ratios, which can turn critically in the clinical work-up of a symptomatic COVID-19 patient [39,[45][46][47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

“…However, lung tissue weight can be derived from quantitative analysis through volume and mean density assessment, thus allowing a specific differentiation between areas with different gas/tissue ratios, which can turn critically in the clinical work-up of a symptomatic COVID-19 patient [39,[45][46][47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

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Automated Quantitative Lung CT Improves Prognostication in Non-ICU COVID-19 Patients beyond Conventional Biomarkers of Disease

Palumbo

Bruno

et al. 2021

Diagnostics

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(1) Background: COVID-19 continues to represent a worrying pandemic. Despite the high percentage of non-severe illness, a wide clinical variability is often reported in real-world practice. Accurate predictors of disease aggressiveness, however, are still lacking. The purpose of our study was to evaluate the impact of quantitative analysis of lung computed tomography (CT) on non-intensive care unit (ICU) COVID-19 patients’ prognostication; (2) Methods: Our historical prospective study included fifty-five COVID-19 patients consecutively submitted to unenhanced lung CT. Primary outcomes were recorded during hospitalization, including composite ICU admission for the need of mechanical ventilation and/or death occurrence. CT examinations were retrospectively evaluated to automatically calculate differently aerated lung tissues (i.e., overinflated, well-aerated, poorly aerated, and non-aerated tissue). Scores based on the percentage of lung weight and volume were also calculated; (3) Results: Patients who reported disease progression showed lower total lung volume. Inflammatory indices correlated with indices of respiratory failure and high-density areas. Moreover, non-aerated and poorly aerated lung tissue resulted significantly higher in patients with disease progression. Notably, non-aerated lung tissue was independently associated with disease progression (HR: 1.02; p-value: 0.046). When different predictive models including clinical, laboratoristic, and CT findings were analyzed, the best predictive validity was reached by the model that included non-aerated tissue (C-index: 0.97; p-value: 0.0001); (4) Conclusions: Quantitative lung CT offers wide advantages in COVID-19 disease stratification. Non-aerated lung tissue is more likely to occur with severe inflammation status, turning out to be a strong predictor for disease aggressiveness; therefore, it should be included in the predictive model of COVID-19 patients.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 80%

“…with different gas/tissue ratios, which can turn critically in the clinical work-up of a symptomatic COVID-19 patient [39,[45][46][47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Automated Quantitative Lung CT Improves Prognostication in Non-ICU COVID-19 Patients beyond Conventional Biomarkers of Disease

Palumbo

Bruno

et al. 2021

Diagnostics

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“…We read with great interest the article by Coppola and colleagues on the potential role of total lung stress in the disease progression of coronavirus disease 2019 (COVID-19)-related pneumonia [ 1 ]. We thank the authors for their work and appreciate the time and effort involved in performing all measurements including the assessment of the esophageal pressure swing (Δ P eso ) in COVID-19 patients on non-invasive respiratory support.…”

mentioning

confidence: 99%