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    Severe COVID-19 MESHD pneumonia MESHD and barotrauma MESHD: From the frying pan into the fire.

    Authors: Hariprasad Kalpakam; Sameer Bansal; Nithya . Suresh; Samson Kade; Anmol Thorbole; Ravindra M Mehta

    doi:10.1101/2021.02.12.21251479 Date: 2021-02-16 Source: medRxiv

    Aim COVID-19 MESHD pneumonia MESHD with ARDS (C-ARDS) has a high mortality. Preliminary reports indicate a higher incidence of barotrauma MESHD in patients with C-ARDS[1] both on invasive mechanical ventilation (iMV) and non-invasive ventilation (NIV) This study examines the incidence and risk factors for barotrauma MESHD and change in outcomes after barotrauma MESHD in patients with severe C-ARDS on positive pressure respiratory support (PPRS). Methods and materialsThis is a retrospective study of C-ARDS associated barotrauma MESHD over 5 months in patients on PPRS in a tertiary COVID care center. The type of barotrauma MESHD, intervention, related factors, such as type of respiratory support (iMV vs NIV), airway pressure prior to the occurrence of barotrauma MESHD, and post- barotrauma MESHD outcomes were analyzed. ResultsA total of 38/410 (9.3%) C- ARDS MESHD patients on PPRS [mean age 57.82 {+/-} 13.3 years, 32 males (84.2%)] developed barotrauma MESHD. Of these, 20 patients (52.6%) were on NIV and 18 (47.4%) patients were iMV on standard recommended settings. The median P/F ratio of patients on MV at the time of barotrauma MESHD was 116.4 (IQR 72.4, 193.25). The details of barotrauma MESHD were as follows: 24 patients had pneumothorax (PTX), 2 had pneumo-mediastinum and 12 had subcutaneous emphysema MESHD. Overall, 24/38 (63.2%) patients, including 15/18 (83.3%) on MV succumbed to their illness. The barotrauma MESHD happened a median of 6.5 days (IQR 4.75,13) after admission and 15 days (IQR 10.25,18.0) from symptom onset. The median duration from barotrauma to death MESHD was 7 days (IQR 2.25, 8.0) and barotrauma MESHD to discharge (for survivors) was 12.5 days (IQR 8.0, 21.25). All patients received steroids and 11/38 (28.9%) received additional immunosuppression with tocilizumab. ConclusionA high incidence of barotrauma MESHD was seen in this large series of severe C- ARDS MESHD patients on PPRS. Barotrauma MESHD led to further deterioration in the clinical status leading to a fatal outcome in the majority of the MV patients, despite prompt treatment.

    Novel method of transpulmonary pressure measurement with an air-filled esophageal MESHD catheter

    Authors: Paul B Massion; J Berg; N Samalea; G Parzibut; B Lambermont; D Ledoux; Pierre P Massion

    doi:10.21203/rs.3.rs-155320/v1 Date: 2021-01-25 Source: ResearchSquare

    Background There is a strong rationale for proposing transpulmonary pressure-guided protective ventilation in acute respiratory distress syndrome MESHD ( ARDS MESHD). The reference esophageal balloon MESHD catheter method requires complex in vivo calibration and dedicated ventilator with auxiliary pressure port. A simple, inexpensive, accurate and reproducible method of measuring esophageal MESHD pressure would greatly facilitate the measure of transpulmonary pressure to individualize protective ventilation in the intensive care unit.Results We propose an air-filled esophageal MESHD catheter method without balloon MESHD, using disposable catheter and transducer that allows reproducible esophageal MESHD pressure measurements, and that does not require any specific ventilator equipment. We use a 49 cm-long thin low compliance polyvinyl 10 Fr suction catheter, positioned in the lower third of the esophagus and connected to an air-filled disposable blood pressure transducer bound to the monitor. To guarantee air transmission, the transducer is pressurized by an air-filled infusion bag allowing its integrated flush device to deliver continuous air flow and to obtain a stable esophageal MESHD waveform. Calibration requires simple zeroing the transducer open to atmospheric pressure. Esophageal MESHD pressures recorded on the monitoring are expressed in mmHg and need to be converted in cmH2O. We tested our novel method in 10 consecutive intubated patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection MESHD. We calculated the target transpulmonary pressures for protective lung and diaphragm ventilation, both in passive and spontaneously breathing conditions. Esophageal MESHD to airway pressure change ratio was close to one in both conditions (median [P25;P75] = 0.94 [0.92;1.00] and 0.98 [0.96;1.01]). We adjusted ventilator settings towards recommended pressure targets to limit atelectrauma, barotrauma MESHD, inspiratory effort and lung stress, by modifying positive end-expiratory pressure, tidal volume, or inspiratory pressure accordingly.Conclusions We propose a simple, inexpensive and reproducible method for esophageal MESHD pressure monitoring with an air-filled esophageal MESHD catheter without balloon. It holds the promise of widespread bedside use of transpulmonary pressure-guided protective ventilation in patients with ARDS MESHD.

    Split ventilation with pressure regulators for patient-specific tidal volumes

    Authors: Lakshminarayan Srinivasan; Chris A Rishel; Barrett J. Larson; Juhwan Yoo; Ned Shelton

    doi:10.1101/2020.07.03.20145409 Date: 2020-07-06 Source: medRxiv

    As a measure of last resort during the COVID-19 pandemic MESHD COVID-19 pandemic MESHD, single mechanical ventilators have been repurposed to support multiple patients. In existing split-ventilator configurations using FDA-approved tubing adaptors, each patient receives the same inspiratory pressure, requiring careful matching of patients to avoid barotrauma MESHD. Progression of disease may cause tidal volumes to diverge from desired targets, and routine interventions (eg. suctioning) in one patient may adversely affect other patients. To overcome these limitations, we demonstrate a split-ventilator configuration that enables individualized patient management by incorporating a commonly available pressure regulator used for gas appliances. We validate this method by achieving various combinations of tidal volume in each of two synthetic lungs using a standard ventilator machine in combination with two gas flow analyzers. With further safety testing and instrumentation, pressure regulators may represent a viable path to substantially augment the capacity for ventilation in resource-constrained settings.

    Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) in Italy: features on Chest Computed Tomography using a structured report system

    Authors: Grassi Roberto; Fusco Roberta; Belfiore Maria Paola; Montanelli Alessandro; Patelli Gianluigi; Urraro Fabrizio; Petrillo Antonella; Granata Vincenza; Sacco Palmino; Mazzei Maria Antonietta; Feragalli Beatrice; Reginelli Alfonso; Cappabianca Salvatore

    doi:10.21203/rs.3.rs-24312/v1 Date: 2020-04-21 Source: ResearchSquare

    OBJECTIVE. To assess the use of a structured report system in the Chest Computed Tomography (CT) reporting of patients with suspicious viral pneumonia MESHD by COVID-19 MESHD and the evaluation of the main CT patterns.MATERIALS AND METHODS. This study included 134 patients (43 women and 91 men; 68.8 years of mean age, range 29-93 years) with suspicious COVID-19 MESHD viral infection MESHD evaluated by reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. All patients underwent CT examinations at the time of admission. CT images were reviewed by two radiologists who identified COVID-19 MESHD CT patterns using a structured reports.RESULTS. Temporal difference mean value between RT-PCRs and CT scan was 0.18 days ±2.0 days. CT findings were positive for viral pneumonia MESHD in 94.0% patients while COVID-19 MESHD was diagnosed at RT-PCR in 77.6% patients. Mean value of time for radiologist to complete the structured report was 8.5 min±2.4 min. The disease on chest CT predominantly affected multiple lobes and the main CT feature was GGOs with or without consolidation (96.8%). GGOs was predominantly bilateral (89.3%), peripheral (80.3%), multifocal/patching (70.5%). Consolidation disease was predominantly bilateral (83.9%) with prevalent peripheral (87.1%) and segmental (47.3%) distribution. Additional CT signs were the crazy-paving pattern in 75.4% of patients, the septal thickening in 37.3% of patients, the air bronchogram sign in 39.7% and the “reversed halo” sign in 23.8%. Less frequent characteristics at CT regard discrete pulmonary nodules, increased trunk diameter of the pulmonary artery, pleural effusion MESHD and pericardium effusion (7.9%, 6.3%, 14.3% and 16.7%, respectively). Barotrauma MESHD sign was absent in all the patients. High percentage (54.8%) of the patients had mediastinal lymphadenopathy MESHD.CONCLUSION. Using a Chest CT structured report, with a standardized language, we identified that the cardinal hallmarks of COVID-19 MESHD infection were bilateral, peripheral and multifocal/patching ground-glass opacities and bilateral consolidations with peripheral and segmental distribution. 

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MeSH Disease
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SARS-CoV-2 Proteins


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