Scientific Reports (Aug 2022)

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

  • Serge J. H. Heines,
  • Bas C. T. van Bussel,
  • Melanie J. Acampo-de Jong,
  • Frank C. Bennis,
  • Rob J. J. van Gassel,
  • Rald V. M. Groven,
  • Nanon F. L. Heijnen,
  • Ben J. M. Hermans,
  • René Hounjet,
  • Johan van Koll,
  • Mark M. G. Mulder,
  • Marcel C. G. van de Poll,
  • Frank van Rosmalen,
  • Ruud Segers,
  • Sander Steyns,
  • Ulrich Strauch,
  • Jeanette Tas,
  • Iwan C. C. van der Horst,
  • Sander M. J. van Kuijk,
  • Dennis C. J. J. Bergmans

DOI
https://doi.org/10.1038/s41598-022-18843-z
Journal volume & issue
Vol. 12, no. 1
pp. 1 – 10

Abstract

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Abstract 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 PaO2/FiO2-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) cmH2O vs. 11.3 (SD 3.4) cmH2O, (p = 0.475), for ICU survivors and non-survivors. At day 1–3, compliance was ~ 55 mL/cmH2O vs. ~ 45 mL/cmH2O in survivors vs. non-survivors. The intersection of overdistension and collapse curves appeared similar at a PEEP of ~ 12–13 cmH2O. At day 4–6 compliance changed to ~ 50 mL/cmH2O vs. ~ 38 mL/cmH2O. At day 7 and beyond, compliance was ~ 38 mL/cmH2O with the intersection at a PEEP of ~ 9 cmH2O vs. ~ 25 mL/cmH2O with overdistension intersecting at collapse curves at a PEEP of ~ 7 cmH2O. 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.