Chest dual-energy CT to assess the effects of steroids on lung function in severe COVID-19 patients.
COVID-19
Dual-energy CT
Hypoxic pulmonary vasoconstriction
Steroids
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
25 10 2022
25 10 2022
Historique:
received:
28
02
2022
accepted:
12
10
2022
entrez:
26
10
2022
pubmed:
27
10
2022
medline:
28
10
2022
Statut:
epublish
Résumé
Steroids have been shown to reduce inflammation, hypoxic pulmonary vasoconstriction (HPV) and lung edema. Based on evidence from clinical trials, steroids are widely used in severe COVID-19. However, the effects of steroids on pulmonary gas volume and blood volume in this group of patients are unexplored. Profiting by dual-energy computed tomography (DECT), we investigated the relationship between the use of steroids in COVID-19 and distribution of blood volume as an index of impaired HPV. We also investigated whether the use of steroids influences lung weight, as index of lung edema, and how it affects gas distribution. Severe COVID-19 patients included in a single-center prospective observational study at the intensive care unit at Uppsala University Hospital who had undergone DECT were enrolled in the current study. Patients' cohort was divided into two groups depending on the administration of steroids. From each patient's DECT, 20 gas volume maps and the corresponding 20 blood volume maps, evenly distributed along the cranial-caudal axis, were analyzed. As a proxy for HPV, pulmonary blood volume distribution was analyzed in both the whole lung and the hypoinflated areas. Total lung weight, index of lung edema, was estimated. Sixty patients were analyzed, whereof 43 received steroids. Patients not exposed to steroids showed a more extensive non-perfused area (19% vs 13%, p < 0.01) and less homogeneous pulmonary blood volume of hypoinflated areas (kurtosis: 1.91 vs 2.69, p < 0.01), suggesting a preserved HPV compared to patients treated with steroids. Moreover, patients exposed to steroids showed a significantly lower lung weight (953 gr vs 1140 gr, p = 0.01). A reduction in alveolar-arterial difference of oxygen followed the treatment with steroids (322 ± 106 mmHg at admission vs 267 ± 99 mmHg at DECT, p = 0.04). The use of steroids might cause impaired HPV and might reduce lung edema in severe COVID-19. This is consistent with previous findings in other diseases. Moreover, a reduced lung weight, as index of decreased lung edema, and a more homogeneous distribution of gas within the lung were shown in patients treated with steroids. Clinical Trials ID: NCT04316884, Registered March 13, 2020.
Sections du résumé
BACKGROUND
Steroids have been shown to reduce inflammation, hypoxic pulmonary vasoconstriction (HPV) and lung edema. Based on evidence from clinical trials, steroids are widely used in severe COVID-19. However, the effects of steroids on pulmonary gas volume and blood volume in this group of patients are unexplored.
OBJECTIVE
Profiting by dual-energy computed tomography (DECT), we investigated the relationship between the use of steroids in COVID-19 and distribution of blood volume as an index of impaired HPV. We also investigated whether the use of steroids influences lung weight, as index of lung edema, and how it affects gas distribution.
METHODS
Severe COVID-19 patients included in a single-center prospective observational study at the intensive care unit at Uppsala University Hospital who had undergone DECT were enrolled in the current study. Patients' cohort was divided into two groups depending on the administration of steroids. From each patient's DECT, 20 gas volume maps and the corresponding 20 blood volume maps, evenly distributed along the cranial-caudal axis, were analyzed. As a proxy for HPV, pulmonary blood volume distribution was analyzed in both the whole lung and the hypoinflated areas. Total lung weight, index of lung edema, was estimated.
RESULTS
Sixty patients were analyzed, whereof 43 received steroids. Patients not exposed to steroids showed a more extensive non-perfused area (19% vs 13%, p < 0.01) and less homogeneous pulmonary blood volume of hypoinflated areas (kurtosis: 1.91 vs 2.69, p < 0.01), suggesting a preserved HPV compared to patients treated with steroids. Moreover, patients exposed to steroids showed a significantly lower lung weight (953 gr vs 1140 gr, p = 0.01). A reduction in alveolar-arterial difference of oxygen followed the treatment with steroids (322 ± 106 mmHg at admission vs 267 ± 99 mmHg at DECT, p = 0.04).
CONCLUSIONS
The use of steroids might cause impaired HPV and might reduce lung edema in severe COVID-19. This is consistent with previous findings in other diseases. Moreover, a reduced lung weight, as index of decreased lung edema, and a more homogeneous distribution of gas within the lung were shown in patients treated with steroids.
TRIAL REGISTRATION
Clinical Trials ID: NCT04316884, Registered March 13, 2020.
Identifiants
pubmed: 36284360
doi: 10.1186/s13054-022-04200-z
pii: 10.1186/s13054-022-04200-z
pmc: PMC9595078
doi:
Substances chimiques
Oxygen
S88TT14065
Steroids
0
Banques de données
ClinicalTrials.gov
['NCT04316884']
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
328Informations de copyright
© 2022. The Author(s).
Références
Intensive Care Med Exp. 2017 Dec;5(1):19
pubmed: 28378187
J Thorac Dis. 2017 Sep;9(9):3319-3345
pubmed: 29221318
Chest. 2017 Jan;151(1):181-192
pubmed: 27645688
Intensive Care Med. 2010 Nov;36(11):1836-44
pubmed: 20689909
Am Rev Respir Dis. 1986 Jun;133(6):1037-42
pubmed: 3487264
Spartan Med Res J. 2019 Mar 4;3(3):7111
pubmed: 33655150
Radiol Cardiothorac Imaging. 2020 Jun 18;2(3):e200277
pubmed: 34036264
Am J Respir Crit Care Med. 2016 Mar 15;193(6):652-61
pubmed: 26569033
Lancet Infect Dis. 2020 Dec;20(12):1365-1366
pubmed: 32359410
Am J Respir Crit Care Med. 2001 Nov 1;164(9):1701-11
pubmed: 11719313
Ann Intensive Care. 2014 Aug 22;4:28
pubmed: 25593744
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
COPD. 2011 Feb;8(1):13-20
pubmed: 21299474
Thorax. 2017 May;72(5):396-397
pubmed: 28232508
Lancet Respir Med. 2021 Jun;9(6):665-672
pubmed: 34000237
J Appl Physiol (1985). 2021 Mar 1;130(3):865-876
pubmed: 33439790
Radiographics. 2014 Nov-Dec;34(7):1769-90
pubmed: 25384277
Am J Respir Crit Care Med. 2017 Oct 1;196(7):834-844
pubmed: 28644040
Chest. 2017 Jul;152(1):181-193
pubmed: 28267435
Eur Respir Rev. 2021 Sep 15;30(161):
pubmed: 34526314
J Pharm Anal. 2021 Aug;11(4):383-397
pubmed: 33842018
Nature. 2020 Dec;588(7839):553
pubmed: 33328621
J Mol Med (Berl). 2021 Jan;99(1):93-106
pubmed: 33269412
BMC Anesthesiol. 2015 Mar 18;15:36
pubmed: 25805960
AJR Am J Roentgenol. 2006 May;186(5):1272-9
pubmed: 16632718
Eur Heart J. 2020 Sep 1;41(32):3038-3044
pubmed: 32882706
Cardiovasc Res. 2006 Oct 1;72(1):41-50
pubmed: 16904089
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
Compr Physiol. 2011 Jan;1(1):39-59
pubmed: 23737163
J Thorac Imaging. 2009 May;24(2):152-9
pubmed: 19465844
Lancet Respir Med. 2021 Jun;9(6):622-642
pubmed: 33965003
Intensive Care Med. 2021 May;47(5):521-537
pubmed: 33876268
N Engl J Med. 2005 Oct 20;353(16):1711-23
pubmed: 16236742
Int J Mol Sci. 2020 Oct 29;21(21):
pubmed: 33138181
Front Immunol. 2021 Feb 22;12:627579
pubmed: 33692801
Lancet Respir Med. 2020 Mar;8(3):267-276
pubmed: 32043986
Cochrane Database Syst Rev. 2021 Aug 16;8:CD014963
pubmed: 34396514
AJR Am J Roentgenol. 2012 Nov;199(5 Suppl):S40-53
pubmed: 23097167
Respir Physiol Neurobiol. 2014 Sep 15;201:60-70
pubmed: 25026158
J Appl Physiol (1985). 2002 Oct;93(4):1533-41
pubmed: 12235056
Acta Anaesthesiol Scand. 2004 Oct;48(9):1123-9
pubmed: 15352958
Med Phys. 2009 May;36(5):1602-9
pubmed: 19544776
JAMA. 2021 Apr 27;325(16):1620-1630
pubmed: 33734299
Crit Care Med. 2020 Aug;48(8):1129-1134
pubmed: 32697482
Crit Care. 2021 Aug 4;25(1):276
pubmed: 34348797
Acta Physiol Scand. 1966 May;67(1):10-20
pubmed: 5963295
Future Oncol. 2015;11(4):591-606
pubmed: 25686115
Am J Respir Crit Care Med. 2004 Sep 15;170(6):647-55
pubmed: 15184203
Cochrane Database Syst Rev. 2020 Dec 25;12:CD004454
pubmed: 33368142
Crit Care. 2021 Jun 21;25(1):214
pubmed: 34154635
Clin Exp Med. 2020 Nov;20(4):493-506
pubmed: 32720223