Lung mechanics in type L CoVID-19 pneumonia: a pseudo-normal ARDS

Area of Science:

• Critical Care Medicine
• Pulmonology
• Respiratory Physiology

Background:

• COVID-19 pneumonia can lead to Acute Respiratory Distress Syndrome (ARDS).
• Understanding lung mechanics in early COVID-19 is crucial for patient management.
• Prone positioning is a common intervention for ARDS, but its effects on COVID-19 lung mechanics require detailed investigation.

Purpose of the Study:

• To systematically analyze lung mechanics during the early stages of COVID-19 pneumonia.
• To investigate how prone positioning affects respiratory system and transpulmonary parameters in these patients.

Main Methods:

• Four patients with COVID-19 pneumonia were studied in an Intensive Care Unit.
• Esophageal balloon catheter was used to measure esophageal pressure.
• Respiratory system and transpulmonary parameters, including mechanical power and arterial blood gases, were measured every 6 hours, before and after changes in patient positioning (supine to prone).

Main Results:

• Patients exhibited pseudo-normal respiratory mechanics, with respiratory system compliance (C_RS) around 40.8 ml/cmH₂O and driving pressure (DP_RS) around 9.7 cmH₂O.
• Transpulmonary parameters also indicated pseudo-normal mechanics (C_L 53.1 ml/cmH₂O, DP_L 7.9 cmH₂O).
• Prone positioning was associated with a trend towards worsening respiratory mechanical properties over time, indicated by decreased compliance (C_RS,PR 41.5 ml/cmH₂O, C_L,PR 53.2 ml/cmH₂O) compared to supine (C_RS,SUP 56.3 ml/cmH₂O, C_L,SUP 80.8 ml/cmH₂O).

Conclusions:

• Despite severe ARDS, early COVID-19 pneumonia presents with pseudo-normal respiratory system and lung mechanics.
• Prone positioning may lead to a deterioration of these mechanical properties in COVID-19 patients.
• Further research is needed to elucidate the implications of these findings on clinical outcomes.