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Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation

PURPOSE: COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an...

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Autores principales: Dalpiaz, Giorgia, Gamberini, Lorenzo, Carnevale, Aldo, Spadaro, Savino, Mazzoli, Carlo Alberto, Piciucchi, Sara, Allegri, Davide, Capozzi, Chiara, Neziri, Ersenad, Bartolucci, Maurizio, Muratore, Francesco, Coppola, Francesca, Poerio, Antonio, Giampalma, Emanuela, Baldini, Luca, Tonetti, Tommaso, Cappellini, Iacopo, Colombo, Davide, Zani, Gianluca, Mellini, Lorenzo, Agnoletti, Vanni, Damiani, Federica, Gordini, Giovanni, Laici, Cristiana, Gola, Giuliano, Potalivo, Antonella, Montomoli, Jonathan, Ranieri, Vito Marco, Russo, Emanuele, Taddei, Stefania, Volta, Carlo Alberto, Scaramuzzo, Gaetano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Milan 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761248/
https://www.ncbi.nlm.nih.gov/pubmed/35034320
http://dx.doi.org/10.1007/s11547-021-01444-7
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author Dalpiaz, Giorgia
Gamberini, Lorenzo
Carnevale, Aldo
Spadaro, Savino
Mazzoli, Carlo Alberto
Piciucchi, Sara
Allegri, Davide
Capozzi, Chiara
Neziri, Ersenad
Bartolucci, Maurizio
Muratore, Francesco
Coppola, Francesca
Poerio, Antonio
Giampalma, Emanuela
Baldini, Luca
Tonetti, Tommaso
Cappellini, Iacopo
Colombo, Davide
Zani, Gianluca
Mellini, Lorenzo
Agnoletti, Vanni
Damiani, Federica
Gordini, Giovanni
Laici, Cristiana
Gola, Giuliano
Potalivo, Antonella
Montomoli, Jonathan
Ranieri, Vito Marco
Russo, Emanuele
Taddei, Stefania
Volta, Carlo Alberto
Scaramuzzo, Gaetano
author_facet Dalpiaz, Giorgia
Gamberini, Lorenzo
Carnevale, Aldo
Spadaro, Savino
Mazzoli, Carlo Alberto
Piciucchi, Sara
Allegri, Davide
Capozzi, Chiara
Neziri, Ersenad
Bartolucci, Maurizio
Muratore, Francesco
Coppola, Francesca
Poerio, Antonio
Giampalma, Emanuela
Baldini, Luca
Tonetti, Tommaso
Cappellini, Iacopo
Colombo, Davide
Zani, Gianluca
Mellini, Lorenzo
Agnoletti, Vanni
Damiani, Federica
Gordini, Giovanni
Laici, Cristiana
Gola, Giuliano
Potalivo, Antonella
Montomoli, Jonathan
Ranieri, Vito Marco
Russo, Emanuele
Taddei, Stefania
Volta, Carlo Alberto
Scaramuzzo, Gaetano
author_sort Dalpiaz, Giorgia
collection PubMed
description PURPOSE: COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. MATERIAL AND METHODS: All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected. RESULTS: A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning. CONCLUSIONS: The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. Trial Registration: NCT04411459 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11547-021-01444-7.
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spelling pubmed-87612482022-01-18 Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation Dalpiaz, Giorgia Gamberini, Lorenzo Carnevale, Aldo Spadaro, Savino Mazzoli, Carlo Alberto Piciucchi, Sara Allegri, Davide Capozzi, Chiara Neziri, Ersenad Bartolucci, Maurizio Muratore, Francesco Coppola, Francesca Poerio, Antonio Giampalma, Emanuela Baldini, Luca Tonetti, Tommaso Cappellini, Iacopo Colombo, Davide Zani, Gianluca Mellini, Lorenzo Agnoletti, Vanni Damiani, Federica Gordini, Giovanni Laici, Cristiana Gola, Giuliano Potalivo, Antonella Montomoli, Jonathan Ranieri, Vito Marco Russo, Emanuele Taddei, Stefania Volta, Carlo Alberto Scaramuzzo, Gaetano Radiol Med Chest Radiology PURPOSE: COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. MATERIAL AND METHODS: All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected. RESULTS: A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning. CONCLUSIONS: The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. Trial Registration: NCT04411459 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11547-021-01444-7. Springer Milan 2022-01-16 2022 /pmc/articles/PMC8761248/ /pubmed/35034320 http://dx.doi.org/10.1007/s11547-021-01444-7 Text en © Italian Society of Medical Radiology 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Chest Radiology
Dalpiaz, Giorgia
Gamberini, Lorenzo
Carnevale, Aldo
Spadaro, Savino
Mazzoli, Carlo Alberto
Piciucchi, Sara
Allegri, Davide
Capozzi, Chiara
Neziri, Ersenad
Bartolucci, Maurizio
Muratore, Francesco
Coppola, Francesca
Poerio, Antonio
Giampalma, Emanuela
Baldini, Luca
Tonetti, Tommaso
Cappellini, Iacopo
Colombo, Davide
Zani, Gianluca
Mellini, Lorenzo
Agnoletti, Vanni
Damiani, Federica
Gordini, Giovanni
Laici, Cristiana
Gola, Giuliano
Potalivo, Antonella
Montomoli, Jonathan
Ranieri, Vito Marco
Russo, Emanuele
Taddei, Stefania
Volta, Carlo Alberto
Scaramuzzo, Gaetano
Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title_full Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title_fullStr Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title_full_unstemmed Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title_short Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation
title_sort clinical implications of microvascular ct scan signs in covid-19 patients requiring invasive mechanical ventilation
topic Chest Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761248/
https://www.ncbi.nlm.nih.gov/pubmed/35034320
http://dx.doi.org/10.1007/s11547-021-01444-7
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