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      Semi-quantitative chest-CT severity score predicts failure of non-invasive positive pressure ventilation in people hospitalized for COVID-19 pneumonia : Short title: CT score in COVID-19 pneumonia

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          Abstract

          Objective

          Non-invasive positive pressure ventilation (NPPV) emerged as an efficient tool for treatment of Coronavirus disease-19 (COVID-19) pneumonia. The factors influencing NPPV failure are still elusive. The aim of the study was to investigate the relationships between semiquantitative chest computed tomography (CT) scoring and NPPV failure and mortality in patients with COVID-19

          Design

          Observational study

          Setting

          Non-intensive setting of care

          Participants

          N=112 patients consecutively admitted for COVID-19 pneumonia.

          Interventions

          Usual care including various degrees of respiratory support

          Measurements and Main Results

          The semi-quantitative CT-score was calculated 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 study's primary endpoint was the use of NPPV. The secondary endpoints were NPPV failure and in-hospital death, respectively. CT-score progressively increased among groups (6 vs 9 vs 14, p<0.05 between all). CT-score was an independent predictor of all study endpoints (primary endpoint: 1.25 [95% CI 1.1-1.4], p=0.001; NPPV failure: 1.41 [95% CI 1.18-1.69], p<0.001; in-hospital mortality: 1.21 [95% CI 1.07-1.38], p=0.003). 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 with p<0.001; p<0.05 vs other variables).

          Conclusions

          We reported the common and effective use of NPPV in patients with COVID-19 pneumonia. In our population, a semi-quantitative chest CT analysis at hospital admission accurately identified those people poorly responding to NPPV.

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          Author and article information

          Journal
          J Cardiothorac Vasc Anesth
          J Cardiothorac Vasc Anesth
          Journal of Cardiothoracic and Vascular Anesthesia
          Elsevier Inc.
          1053-0770
          1532-8422
          11 September 2021
          11 September 2021
          Affiliations
          [1 ]Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
          [2 ]Radiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
          [3 ]San Raffaele, Rome, Italy
          [4 ]Covid-Internal Medicine Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
          Author notes
          [* ]Corresponding Author: Luca Arcari, MD, Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy. Tel: 00390624291425.
          Article
          S1053-0770(21)00823-5
          10.1053/j.jvca.2021.09.010
          8434692
          8d94310e-0902-4f65-b239-9b29cb2dc39b
          © 2021 Elsevier Inc. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          Categories
          Article

          covid-19,chest computed tomography,non-invasive ventilation,intubation,pneumonia

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