Chest CT score predicts response of COVID-19 pneumonia patients to ventilation: Study
Italy: A recent study published in the Journal of Cardiothoracic and Vascular Anesthesia, has reported the effective use of non-invasive positive pressure ventilation (NPPV) in COVID-19 pneumonia patients. Luca Arcari, Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy, and colleagues found that a semi-quantitative chest CT analysis at hospital admission may accurately identify people who respond poorly to NPPV.
Coronavirus disease-19 (COVID-19) is a respiratory tract infection having a significant rate of respiratory insufficiency, mortality, hospitalization need. NPPV is an emerging efficient tool for the treatment of Coronavirus disease-19 (COVID-19) pneumonia. However, the factors that influence the failure of NPPV are still elusive. Arcari and the team aimed to investigate the relationships between semiquantitative chest computed tomography (CT) scoring and NPPV failure and mortality in patients with COVID-19 in an observational study.
The study included 112 patients consecutively admitted for COVID-19 pneumonia. At hospital admission, the researchers calculated a semi-quantitative CT-score at hospital admission. Subgroups were identified according to the ventilation strategy used (oxygen delivered by Venturi mask n=53; NPPV-responder n=38; NPPV-failure n=21). The primary endpoint of the study was NPPV use. The secondary endpoints were NPPV failure and in-hospital death, respectively.
The study yielded the following findings:
- CT-score progressively increased among groups (6 vs 9 vs 14).
- CT-score was an independent predictor of all study endpoints (primary endpoint: 1.25; NPPV failure: 1.41; in-hospital mortality: 1.21).
- According to receiver operator characteristics curve analysis, CT-score was the most accurate variable for prediction of NPPV failure (area under the curve 0.862).
Arcari and colleagues concluded, "In our population, NPPV was an effective tool for the management of COVID-19 pneumonia-related respiratory insufficiency outside ICUs. Semi-quantitative chest CT analysis at hospital admission provided highly reproducible prognostic information, especially in terms of responsiveness to NPPV." However, researchers stress the need for further studies to fully assess if the routine implementation of CT score to guide clinical management might bring advantages in the care of COVID-19 pneumonia patients.
Reference:
The study titled, "Semi-quantitative chest-CT severity score predicts failure of non-invasive positive pressure ventilation in people hospitalized for COVID-19 pneumonia," is published in the Journal of Cardiothoracic and Vascular Anesthesia.
DOI: https://www.jcvaonline.com/article/S1053-0770(21)00823-5/fulltext
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