Pulmonary pathophysiology development of COVID-19 assessed by serial Electrical Impedance Tomography in the MaastrICCht cohort

• Published in: Scientific reports Vol. 12; no. 1; p. 14517
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25.08.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/1807/1809; 692/308/409; 692/699/1785/3193; Alveoli; COVID-19; Electrical impedance; Humanities and Social Sciences; Impedance; Intubation; Lung diseases; Mechanical ventilation; multidisciplinary; Observational studies; Science; Science (multidisciplinary); Severe acute respiratory syndrome coronavirus 2; Tomography; Ventilation
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-18843-z

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 PaO 2 /FiO 2 -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) cmH 2 O vs. 11.3 (SD 3.4) cmH 2 O, ( p  = 0.475), for ICU survivors and non-survivors. At day 1–3, compliance was ~ 55 mL/cmH 2 O vs. ~ 45 mL/cmH 2 O in survivors vs. non-survivors. The intersection of overdistension and collapse curves appeared similar at a PEEP of ~ 12–13 cmH 2 O. At day 4–6 compliance changed to ~ 50 mL/cmH 2 O vs. ~ 38 mL/cmH 2 O. At day 7 and beyond, compliance was ~ 38 mL/cmH 2 O with the intersection at a PEEP of ~ 9 cmH 2 O vs. ~ 25 mL/cmH 2 O with overdistension intersecting at collapse curves at a PEEP of ~ 7 cmH 2 O. 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.