Quantitative image analysis in COVID-19 acute respiratory distress syndrome: a cohort observational study. [version 2; peer review: 1 approved, 1 approved with reservations]

• Published in: F1000 research Vol. 10; p. 1266
• Main Authors: Dolinay, Tamas, Jun, Dale, Maller, Abigail, Chung, Augustine, Grimes, Brandon, Hsu, Lillian, Nelson, David, Villagas, Bianca, Kim, Grace Hyun J, Goldin, Jonathan
• Format: Journal Article
• Language: English
• Published: London Faculty of 1000 Ltd 24-05-2022; F1000 Research Limited
• Subjects: Cardiovascular disease; Computed tomography; Coronaviruses; COVID-19; Demographics; Diabetes; Edema; Enrollments; Ethnicity; Heart failure; Hispanic Americans; Hospitalization; Hypertension; Image processing; Intensive care; Kidney diseases; Lung diseases; Mechanical ventilation; Medical imaging; Mortality; Observational studies; Ostomy; Oxygen; Patients; Pneumonia; Pneumothorax; Pulmonary fibrosis; Respiratory distress syndrome; Statistical analysis; Tracheostomy; Ventilators; Los Angeles California; United States > US; COVID-19; acute respiratory distress syndrome; quantitative high-resolution lung CT scanning
• ISSN: 2046-1402; 2046-1402
• DOI: 10.12688/f1000research.75311.2

Background
Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury commonly associated with pneumonia, including coronavirus disease-19 (COVID-19). The resultant effect can be persistent lung damage, but its extent is not known. We used quantitative high resolution computed tomography (QHR-CT) lung scans to radiographically characterize the lung damage in COVID-19 ARDS (CARDS) survivors.
Methods
Patients with CARDS (N=20) underwent QHR-CT lung scans 60 to 90 days after initial diagnosis, while hospitalized at a long-term acute care hospital (LTACH). QHR-CT assessed for mixed disease (QMD), ground glass opacities (QGGO), consolidation (QCON) and normal lung tissue (QNL). QMD was correlated with respiratory support on admission, tracheostomy decannulation and supplementary oxygen need on discharge.
Results
Sixteen patients arrived with tracheostomy requiring invasive mechanical ventilation. Four patients arrived on nasal oxygen support. Of the patients included in this study 10 had the tracheostomy cannula removed, four remained on invasive ventilation, and two died. QHR-CT showed 45% QMD, 28.1% QGGO, 3.0% QCON and QNL=23.9%. Patients with mandatory mechanical ventilation had the highest proportion of QMD when compared to no mechanical ventilation. There was no correlation between QMD and tracheostomy decannulation or need for supplementary oxygen at discharge.
Conclusions
Our data shows severe ongoing lung injury in patients with CARDS, beyond what is usually expected in ARDS. In this severely ill population, the extent of mixed disease correlates with mechanical ventilation, signaling formation of interstitial lung disease. QHR-CT analysis can be useful in the post-acute setting to evaluate for interstitial changes in ARDS.