Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study
Abstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00716-1 |
| _version_ | 1819277093745197056 |
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| author | J.-L. Diehl N. Peron R. Chocron B. Debuc E. Guerot C. Hauw-Berlemont B. Hermann J. L. Augy R. Younan A. Novara J. Langlais L. Khider N. Gendron G. Goudot J.-F. Fagon T. Mirault D. M. Smadja |
| author_facet | J.-L. Diehl N. Peron R. Chocron B. Debuc E. Guerot C. Hauw-Berlemont B. Hermann J. L. Augy R. Younan A. Novara J. Langlais L. Khider N. Gendron G. Goudot J.-F. Fagon T. Mirault D. M. Smadja |
| author_sort | J.-L. Diehl |
| collection | DOAJ |
| description | Abstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Methods Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1–4] day after intubation (median [IQR]). Measurements and main results Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1–44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721–2434] mL. Gas exchanges were characterized by hypercapnia 55 [44–62] mmHg, high physiological dead-space (V D/V T): 75 [69–85.5] % and ventilatory ratio (VR): 2.9 [2.2–3.4]. V D/V T and VR were significantly correlated: r 2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12–46] cells per mL and 1483 [999–2217] ng/mL, respectively. Conclusions We observed early in the course of COVID-19 ARDS high V D/V T in association with biological markers of endothelial damage and thrombosis. High V D/V T can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process. |
| first_indexed | 2024-12-23T23:50:38Z |
| format | Article |
| id | doaj.art-7bb3ec0f26184e108e698d367bdbacd9 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-23T23:50:38Z |
| publishDate | 2020-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-7bb3ec0f26184e108e698d367bdbacd92022-12-21T17:25:24ZengSpringerOpenAnnals of Intensive Care2110-58202020-07-011011710.1186/s13613-020-00716-1Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating studyJ.-L. Diehl0N. Peron1R. Chocron2B. Debuc3E. Guerot4C. Hauw-Berlemont5B. Hermann6J. L. Augy7R. Younan8A. Novara9J. Langlais10L. Khider11N. Gendron12G. Goudot13J.-F. Fagon14T. Mirault15D. M. Smadja16Université de Paris, Innovative Therapies in Haemostasis, INSERMIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisUniversité de Paris, PARCC, INSERMPlastic Surgery Department, AP-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisVascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de ParisUniversité de Paris, Innovative Therapies in Haemostasis, INSERMEmergency Department, AP–HP, Georges Pompidou European HospitalIntensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de ParisUniversité de Paris, PARCC, INSERMUniversité de Paris, Innovative Therapies in Haemostasis, INSERMAbstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Methods Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1–4] day after intubation (median [IQR]). Measurements and main results Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1–44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721–2434] mL. Gas exchanges were characterized by hypercapnia 55 [44–62] mmHg, high physiological dead-space (V D/V T): 75 [69–85.5] % and ventilatory ratio (VR): 2.9 [2.2–3.4]. V D/V T and VR were significantly correlated: r 2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12–46] cells per mL and 1483 [999–2217] ng/mL, respectively. Conclusions We observed early in the course of COVID-19 ARDS high V D/V T in association with biological markers of endothelial damage and thrombosis. High V D/V T can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process.http://link.springer.com/article/10.1186/s13613-020-00716-1ARDSCOVID-19Physiological dead-spaceVentilatory ratio |
| spellingShingle | J.-L. Diehl N. Peron R. Chocron B. Debuc E. Guerot C. Hauw-Berlemont B. Hermann J. L. Augy R. Younan A. Novara J. Langlais L. Khider N. Gendron G. Goudot J.-F. Fagon T. Mirault D. M. Smadja Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study Annals of Intensive Care ARDS COVID-19 Physiological dead-space Ventilatory ratio |
| title | Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study |
| title_full | Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study |
| title_fullStr | Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study |
| title_full_unstemmed | Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study |
| title_short | Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study |
| title_sort | respiratory mechanics and gas exchanges in the early course of covid 19 ards a hypothesis generating study |
| topic | ARDS COVID-19 Physiological dead-space Ventilatory ratio |
| url | http://link.springer.com/article/10.1186/s13613-020-00716-1 |
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