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 PaO₂/FiO₂ (day 1): non-CARDS (median PaO₂/FiO₂ 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 < 0.001). Each subgroup had similar median lung weight: 1215 g [1083–1294], 1153 [888–1321], 968 [858–1253], 1060 [869–1269], and 1127 [937–1193] (p = 0.37). They also had similar non-aerated tissue fraction: 10.4% [5.9–13.7], 9.6 [7.1–15.8], 9.4 [5.8–16.7], 8.4 [6.7–12.3] and 9.4 [5.9–13.8], respectively (p = 0.85).

Treatment failure of CPAP/NIV occurred in 34 patients (24.3%). Only three variables, at day one, distinguished patients with negative outcome: PaO₂/FiO₂ ratio (OR 0.99 [0.98–0.99], p = 0.02), esophageal pressure swing (OR 1.13 [1.01–1.27], p = 0.032) and total stress (OR 1.17 [1.06–1.31], p = 0.004). When these three variables were evaluated together in a multivariate logistic regression analysis, only the total stress was independently associated with negative outcome (OR 1.16 [1.01–1.33], p = 0.032).

Conclusions

In early COVID-19 pneumonia, hypoxemia is not linked to computed tomography (CT) pathoanatomy, differently from typical ARDS. High lung stress was independently associated with the failure of non-invasive respiratory support.

中文翻译：

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肺总压力在早期 COVID-19 肺炎进展中的作用

目的

我们调查了在无创呼吸支持期间施加于肺部的压力是否可能导致 2019 年冠状病毒病 (COVID-19) 的进展。

方法

单中心、前瞻性、队列研究对 140 名连续接受持续气道正压通气 ( n  = 131) 或无创通气 ( n  = 9) 的高依赖病房的 COVID-19 肺炎患者进行了治疗。我们测量了定量肺计算机断层扫描、食管压力波动和总肺压力。

结果

_{根据基线 PaO 2} /FiO ₂ （第 1 天）将患者分为五个亚组：非卡片（中位 PaO ₂ /FiO ₂ 361 mmHg，IQR [323–379]），轻度（224 mmHg [211–249] )、轻度中度 (173 mmHg [164–185])、中度重度 (126 mmHg [114–138]) 和重度 (88 mmHg [86–99], p  < 0.001)。每个亚组的中位肺重相似：1215 g [1083–1294]、1153 [888–1321]、968 [858–1253]、1060 [869–1269] 和 1127 [937–1193] ( p  = 0.37)。它们也有相似的非充气组织分数：分别为 10.4% [5.9–13.7]、9.6 [7.1–15.8]、9.4 [5.8–16.7]、8.4 [6.7–12.3] 和 9.4 [5.9–13.8] ( p  = 0.85)。

34 名患者 (24.3%) 出现 CPAP/NIV 治疗失败。在第一天，只有三个变量区分了阴性结果的患者：PaO ₂ /FiO ₂比率（OR 0.99 [0.98-0.99]，p  = 0.02），食管压力波动（OR 1.13 [1.01-1.27]，p  = 0.032）和总应力（OR 1.17 [1.06–1.31]，p  = 0.004）。当这三个变量在多变量逻辑回归分析中一起评估时，只有总压力与负面结果独立相关（OR 1.16 [1.01-1.33]，p  = 0.032）。

结论

在早期 COVID-19 肺炎中，低氧血症与计算机断层扫描 (CT) 病理解剖无关，这与典型的 ARDS 不同。高肺压力与无创呼吸支持的失败独立相关。