Pulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging, and Hematologic Observations
| Autor: | Brijesh V. Patel, Deepa R. J. Arachchillage, Tina Xu, Richard Trimlett, Paolo Bianchi, Suveer Singh, Carole A. Ridge, Sarah Trenfield, Christine Weaver, Benjamin Garfield, Cliff Morgan, Stephane Ledot, Susanna Price, S. John Wort, Sujal R. Desai, Louit Thakuria, James Doyle, Simon P. G. Padley, Maurizio Passariello, Anand Devaraj |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
2019-20 coronavirus outbreak medicine.medical_specialty Pulmonary Circulation Coronavirus disease 2019 (COVID-19) Respiratory System Disease mechanical ventilation Critical Care and Intensive Care Medicine medicine.disease_cause Angiopathy 03 medical and health sciences 0302 clinical medicine thoracic imaging Medicine Humans 030212 general & internal medicine Vascular Diseases Intensive care medicine Lung 11 Medical and Health Sciences COVID-19/Respiratory Physiology Coronavirus Physiologic Imaging business.industry SARS-CoV-2 Outbreak COVID-19 Original Articles acute respiratory distress syndrome medicine.disease pulmonary perfusion 030228 respiratory system novel coronavirus disease 2019 Epidemiologic data business |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine |
| ISSN: | 1535-4970 1073-449X |
| Popis: | Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology. Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia. Methods: Clinical, physiologic, and laboratory data were collated. Radiologic (computed tomography (CT) pulmonary angiography [n = 39] and dual-energy CT [DECT, n = 20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence and extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography. Measurements and Results: In 39 consecutive patients (male:female, 32:7; mean age, 53 ± 10 yr [range, 29–79 yr]; Black and minority ethnic, n = 25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead space (dynamic compliance, 33.7 ± 14.7 ml/cm H2O; Murray lung injury score, 3.14 ± 0.53; mean ventilatory ratios, 2.6 ± 0.8) with evidence of hypercoagulability and fibrinolytic “shutdown”. The mean CT extent (±SD) of normally aerated lung, ground-glass opacification, and dense parenchymal opacification were 23.5 ± 16.7%, 36.3 ± 24.7%, and 42.7 ± 27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6). Conclusions: Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|