Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study

J Crit Care. 2020 Dec:60:169-176. doi: 10.1016/j.jcrc.2020.08.006. Epub 2020 Aug 13.

Abstract

Purpose: The aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID-) ARDS patients.

Materials and methods: The study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO2/FiO2 ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO2 table with VT adjusted to 6 ml/kg predicted body weight.

Results: 22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID- patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID- patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID- patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID- patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.

Keywords: Acute respiratory distress syndrome; COVID-19; Computed tomography; Driving pressure; Tidal hyperinflation; Transpulmonary pressure.

MeSH terms

  • Adult
  • Aged
  • COVID-19 / diagnostic imaging*
  • Case-Control Studies
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Lung
  • Lung Compliance
  • Male
  • Middle Aged
  • Positive-Pressure Respiration
  • Prospective Studies
  • Respiratory Distress Syndrome / diagnostic imaging*
  • Tomography, X-Ray Computed*