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Carvajal C, Giraldo Ramirez ND, De La Hoz Castro AD, Vidal Vargas CG, Pacheco HA, Fernández Sánchez D, González Salazar LV, Romero Otta SS, Vergara Jaimes S, Bolivar Ospina JF, Correa Céspedes J, Narvaez Orozco A, Donado JH, Cadavid CA, De La Rosa G. Association of dead space fraction to mortality in patients with COVID-19-related ARDS: A historical cohort observational study. Med Intensiva 2024:S2173-5727(24)00161-9. [PMID: 38906791 DOI: 10.1016/j.medine.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/24/2024] [Accepted: 05/17/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To assess the correlation of dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV) and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation. DESIGN Observational study of a historical cohort. SETTING University hospital in Medellin, Colombia. PARTICIPANTS Patients aged 15 and above with a confirmed COVID-19 diagnosis admitted to the ICU and requiring mechanical ventilation. INTERVENTIONS Measurement of VD/VT, CMV, and VR in COVID-19 patients. MAIN VARIABLES OF INTEREST VD/VT, CMV, VR, demographic data, oxygenation indices and ventilatory parameters. RESULTS During the study period, 1047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. The multivariate analysis revealed independent associations to in-hospital mortality, higher VD/VT (HR 1.24; 95%CI 1.003-1.525; p = 0.046), age (HR 1.024; 95%CI 1.014-1.034; p < 0.001), and SOFA score at onset (HR: 1.036; 95%CI: 1.001-1.07; p = 0.017). CONCLUSIONS VD/VT demonstrated an association with mortality in COVID-19 patients with ARDS on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.
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Affiliation(s)
- Carlos Carvajal
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia; Departamento de Cuidado Crítico de adulto.
| | | | | | - Carlos Guillermo Vidal Vargas
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Hemel Antonio Pacheco
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Laura Vannesa González Salazar
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Silvia Vergara Jaimes
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan Fernando Bolivar Ospina
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juliana Correa Céspedes
- Departamento de Investigación; Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Jorge Hernando Donado
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia; Departamento de Investigación
| | - Carlos Alberto Cadavid
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia; Departamento de Cuidado Crítico de adulto
| | - Gisela De La Rosa
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia; Departamento de Cuidado Crítico de adulto
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Jeltema JL, Gorman EK, Ovrom EA, Ripoll JG, Dominelli PB, Joyner MJ, Welch BT, Senefeld JW, Wiggins CC. Greater central airway luminal area in people with COVID-19: a case-control series. Sci Rep 2022; 12:17970. [PMID: 36289306 PMCID: PMC9606286 DOI: 10.1038/s41598-022-22005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
Respiratory epithelium in the conducting airways of the human body is one of the primary targets of SARS-CoV-2 infection, however, there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. To better understand the pathophysiology of COVID-19 on the size of larger conducting airways, we determined the luminal area of the central airways in patients with a history of COVID-19 compared to a height-matched cohort of controls using a case-control study design. Using three-dimensional reconstruction from low-dose high-resolution computed tomography, we retrospectively assessed airway luminal cross-sectional area in 114 patients with COVID-19 (66 females, 48 males) and 114 healthy, sex- and height-matched controls (66 females, 48 males). People with a history of smoking, cardiopulmonary disease, or a body mass index greater than 40 kg·m-2 were excluded. Luminal areas of seven conducting airways were analyzed, including trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe. For the central conducting airways, luminal area was ~ 15% greater patients with COVID-19 compared to matched controls (p < 0.05). Among patients with COVID-19, there were generally no differences in the luminal areas of the conducting airways between hospitalized patients compared to patients who did not require COVID-19-related hospitalization. Our findings suggest that males and females with COVID-19 have pathologically larger conducting airway luminal areas than healthy, sex- and height-matched controls.
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Affiliation(s)
- Jeffrey L Jeltema
- Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ellen K Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Erik A Ovrom
- Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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3
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du Preez HN, Aldous C, Hayden MR, Kruger HG, Lin J. Pathogenesis of COVID-19 described through the lens of an undersulfated and degraded epithelial and endothelial glycocalyx. FASEB J 2021; 36:e22052. [PMID: 34862979 DOI: 10.1096/fj.202101100rr] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
The glycocalyx surrounds every eukaryotic cell and is a complex mesh of proteins and carbohydrates. It consists of proteoglycans with glycosaminoglycan side chains, which are highly sulfated under normal physiological conditions. The degree of sulfation and the position of the sulfate groups mainly determine biological function. The intact highly sulfated glycocalyx of the epithelium may repel severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) through electrostatic forces. However, if the glycocalyx is undersulfated and 3-O-sulfotransferase 3B (3OST-3B) is overexpressed, as is the case during chronic inflammatory conditions, SARS-CoV-2 entry may be facilitated by the glycocalyx. The degree of sulfation and position of the sulfate groups will also affect functions such as immune modulation, the inflammatory response, vascular permeability and tone, coagulation, mediation of sheer stress, and protection against oxidative stress. The rate-limiting factor to sulfation is the availability of inorganic sulfate. Various genetic and epigenetic factors will affect sulfur metabolism and inorganic sulfate availability, such as various dietary factors, and exposure to drugs, environmental toxins, and biotoxins, which will deplete inorganic sulfate. The role that undersulfation plays in the various comorbid conditions that predispose to coronavirus disease 2019 (COVID-19), is also considered. The undersulfated glycocalyx may not only increase susceptibility to SARS-CoV-2 infection, but would also result in a hyperinflammatory response, vascular permeability, and shedding of the glycocalyx components, giving rise to a procoagulant and antifibrinolytic state and eventual multiple organ failure. These symptoms relate to a diagnosis of systemic septic shock seen in almost all COVID-19 deaths. The focus of prevention and treatment protocols proposed is the preservation of epithelial and endothelial glycocalyx integrity.
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Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Melvin R Hayden
- Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.,Diabetes and Cardiovascular Disease Center, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
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Mälberg J, Hadziosmanovic N, Smekal D. Physiological respiratory parameters in pre-hospital patients with suspected COVID-19: A prospective cohort study. PLoS One 2021; 16:e0257018. [PMID: 34473782 PMCID: PMC8412304 DOI: 10.1371/journal.pone.0257018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023] Open
Abstract
Background The COVID-19 pandemic has presented emergency medical services (EMS) worldwide with the difficult task of identifying patients with COVID-19 and predicting the severity of their illness. The aim of this study was to investigate whether physiological respiratory parameters in pre-hospital patients with COVID-19 differed from those without COVID-19 and if they could be used to aid EMS personnel in the prediction of illness severity. Methods Patients with suspected COVID-19 were included by EMS personnel in Uppsala, Sweden. A portable respiratory monitor based on pneumotachography was used to sample the included patient’s physiological respiratory parameters. A questionnaire with information about present symptoms and background data was completed. COVID-19 diagnoses and hospital admissions were gathered from the electronic medical record system. The physiological respiratory parameters of patients with and without COVID-19 were then analyzed using descriptive statistical analysis and logistic regression. Results Between May 2020 and January 2021, 95 patients were included, and their physiological respiratory parameters analyzed. Of these patients, 53 had COVID-19. Using adjusted logistic regression, the odds of having COVID-19 increased with respiratory rate (95% CI 1.000–1.118), tidal volume (95% CI 0.996–0.999) and negative inspiratory pressure (95% CI 1.017–1.152). Patients admitted to hospital had higher respiratory rates (p<0.001) and lower tidal volume (p = 0.010) compared to the patients who were not admitted. Using adjusted logistic regression, the odds of hospital admission increased with respiratory rate (95% CI 1.081–1.324), rapid shallow breathing index (95% CI 1.006–1.040) and dead space percentage of tidal volume (95% CI 1.027–1.159). Conclusion Patients taking smaller, faster breaths with less pressure had higher odds of having COVID-19 in this study. Smaller, faster breaths and higher dead space percentage also increased the odds of hospital admission. Physiological respiratory parameters could be a useful tool in detecting COVID-19 and predicting hospital admissions, although more research is needed.
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Affiliation(s)
- Johan Mälberg
- Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Center for Prehospital Research, Uppsala University Hospital, Uppsala, Sweden
- Uppsala Emergency Medical Service, Uppsala University Hospital, Uppsala, Sweden
- * E-mail:
| | | | - David Smekal
- Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Center for Prehospital Research, Uppsala University Hospital, Uppsala, Sweden
- Uppsala Emergency Medical Service, Uppsala University Hospital, Uppsala, Sweden
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Sarfraz Z, Sarfraz A, Barrios A, Garimella R, Dominari A, Kc M, Pandav K, Pantoja JC, Retnakumar V, Cherrez-Ojeda I. Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care. J Prim Care Community Health 2021; 12:21501327211023726. [PMID: 34096390 PMCID: PMC8188976 DOI: 10.1177/21501327211023726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.
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Affiliation(s)
- Zouina Sarfraz
- Larkin Health System, South Miami, FL, USA.,Fatima Jinnah Medical University, Lahore, Punjab, Pakistan
| | - Azza Sarfraz
- Larkin Health System, South Miami, FL, USA.,Aga Khan University, Karachi, Sindh, Pakistan
| | - Alanna Barrios
- Larkin Health System, South Miami, FL, USA.,Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | | | | | - Manish Kc
- Larkin Health System, South Miami, FL, USA
| | | | | | | | - Ivan Cherrez-Ojeda
- Universidad Espiritu Santo, Samborondon, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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Physiologic Improvement in Respiratory Acidosis Using Extracorporeal Co 2 Removal With Hemolung Respiratory Assist System in the Management of Severe Respiratory Failure From Coronavirus Disease 2019. Crit Care Explor 2021; 3:e0372. [PMID: 33786448 PMCID: PMC7994071 DOI: 10.1097/cce.0000000000000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives About 15% of hospitalized coronavirus disease 2019 patients require ICU admission, and most (80%) of these require invasive mechanical ventilation. Lung-protective ventilation in coronavirus disease 2019 acute respiratory failure may result in severe respiratory acidosis without significant hypoxemia. Low-flow extracorporeal Co2 removal can facilitate lung-protective ventilation and avoid the adverse effects of severe respiratory acidosis. The objective was to evaluate the efficacy of extracorporeal Co2 removal using the Hemolung Respiratory Assist System in correcting severe respiratory acidosis in mechanically ventilated coronavirus disease 2019 patients with severe acute respiratory failure. Design Retrospective cohort analysis of patients with coronavirus disease 2019 mechanically ventilated with severe hypercapnia and respiratory acidosis and treated with low-flow extracorporeal Co2 removal. Setting Eight tertiary ICUs in the United States. Patients Adult patients supported with the Hemolung Respiratory Assist System from March 1, to September 30, 2020. Interventions Extracorporeal Co2 removal with Hemolung Respiratory Assist System under a Food and Drug Administration emergency use authorization for coronavirus disease 2019. Measurements and Main Results The primary outcome was improvement in pH and Paco2 from baseline. Secondary outcomes included survival to decannulation, mortality, time on ventilator, and adverse events. Thirty-one patients were treated with Hemolung Respiratory Assist System with significant improvement in pH and Pco2 in this cohort. Two patients experienced complications that prevented treatment. Of the 29 treated patients, 58% survived to 48 hours post treatment and 38% to hospital discharge. No difference in age or comorbidities were noted between survivors and nonsurvivors. There was significant improvement in pH (7.24 ± 0.12 to 7.35 ± 0.07; p < 0.0001) and Paco2 (79 ± 23 to 58 ± 14; p < 0.0001) from baseline to 24 hours. Conclusions In this retrospective case series of 29 patients, we have demonstrated efficacy of extracorporeal Co2 removal using the Hemolung Respiratory Assist System to improve respiratory acidosis in patients with severe hypercapnic respiratory failure due to coronavirus disease 2019.
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