Display options
Cite
Gosangi B, Rubinowitz AN, Irugu D, et al. COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. Emerg Radiol. 2021;doi: 10.1007/s10140-021-01976-5.
Gosangi, B., Rubinowitz, A. N., Irugu, D., Gange, C., Bader, A., & Cortopassi, I. (2021). COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. Emergency radiology, . https://doi.org/10.1007/s10140-021-01976-5
Gosangi, Babina, et al. "COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications." Emergency radiology vol. (2021). doi: https://doi.org/10.1007/s10140-021-01976-5
Gosangi B, Rubinowitz AN, Irugu D, Gange C, Bader A, Cortopassi I. COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. Emerg Radiol. 2021 Oct 26; doi: 10.1007/s10140-021-01976-5. Epub 2021 Oct 26. PMID: 34698956; PMCID: PMC8545770.
Copy Download .nbib Format: NLM
Share it on

Emerg Radiol. 2021 Oct 26; doi: 10.1007/s10140-021-01976-5. Epub 2021 Oct 26.

COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications.

Emergency radiology

Babina Gosangi, Ami N Rubinowitz, David Irugu, Christopher Gange, Anna Bader, Isabel Cortopassi

Affiliations

  1. Department of Radiology & Biomedical Imaging, Yale School of Medicine; Thoracic Imaging section, Yale-New Haven Hospital, Yale New Haven Health, New Haven, CT, USA. [email protected].
  2. Department of Radiology & Biomedical Imaging, Yale School of Medicine; Thoracic Imaging section, Yale-New Haven Hospital, Yale New Haven Health, New Haven, CT, USA.
  3. Magnus Hospitals, Hyderabad, India.

PMID: 34698956 PMCID: PMC8545770 DOI: 10.1007/s10140-021-01976-5

Abstract

The first cluster of cases of COVID-19 pneumonia was reported on December 31, 2019. Since then, this disease has spread rapidly across the world, and as of September 17, 2021, there are 226,844,344 cases of COVID-19 worldwide with 4,666,334 deaths related to COVID-19. While most COVID-19 cases are mild, some cases are severe with patients developing acute respiratory distress syndrome (ARDS). The pathophysiology of ARDS includes damage to the alveolar epithelium that leads to increased permeability of the alveolar epithelial barrier causing hyaline membrane formation, interstitial edema, and alveolar edema that results in severe hypoxia. Patients with COVID-19 ARDS are supported by non-invasive or invasive mechanical ventilation with an aim to improve oxygenation and maintain adequate blood oxygen levels. Increased intra-alveolar pressure while on mechanical ventilation may lead to alveolar rupture and thus barotrauma-related injuries such as lung tension cysts, pulmonary interstitial emphysema (PIE), pneumomediastinum, pneumopericardium, and pneumothorax. Recent studies have shown that the rate of barotrauma-related events is higher in patients with COVID-19 ARDS compared to patients with ARDS secondary to other etiologies. Radiologists should be aware of the imaging features of COVID-19 ARDS as well as the complications of mechanical ventilation. This educational manuscript will review the features of COVID-19 ARDS, discuss imaging of patients on mechanical ventilation, and review the imaging features of complications related to mechanical ventilation, including ventilator-associated lung injuries.

© 2021. American Society of Emergency Radiology.

Keywords: ARDS; Acute respiratory distress syndrome; Complications of mechanical ventilation; Covid-19 ARDS; Endotracheal intubation; Pneumomediastinum; Pneumothorax

References

  1. Chan JF-W (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395(10223):514–523 - PubMed
  2. Li F (2016) Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol 3:237–261 - PubMed
  3. Zhou P, Yang X, Wang X, Hu B, Zhang L et al (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579:270–273 - PubMed
  4. Wu Z, McGoogan JM (2020) Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 323(13):1239–1242. https://doi.org/10.1001/jama.2020.2648 - PubMed
  5. Patel A, Jernigan DB, 2019-nCoV CDC Response Team (2020) Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak - United States, December 31, 2019-February 4, 2020. MMWR Morb Mortal Wkly Rep 69(5):140–146. https://doi.org/10.15585/mmwr.mm6905e1 (Erratum in: MMWR Morb Mortal Wkly Rep. 2020 Feb 14;69(6):173) - PubMed
  6. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI (2020) Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 22(369):m1966. https://doi.org/10.1136/bmj.m1966 - PubMed
  7. Wu C, Chen X, Cai Y et al (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [published correction appears in JAMA Intern Med. 2020 Jul 1;180(7):1031]. JAMA Intern Med 180(7):934–943. https://doi.org/10.1001/jamainternmed.2020.0994 - PubMed
  8. Puah SH (2020) ATS and APSR Joint Webinar: Global perspectives on COVID‐19. https://www.apsre​sp.org/archi​ve/2020-covid-19-webin​ar.html . Accessed Feb 2021 - PubMed
  9. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307(23):2526–33. https://doi.org/10.1001/jama.2012.5669 - PubMed
  10. Li X, Ma X (2020) Acute respiratory failure in COVID-19: is it “typical” ARDS? Crit Care 24(1):198. https://doi.org/10.1186/s13054-020-02911-9 - PubMed
  11. Gibson PG, Qin L, Puah SH (2020) COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust 213(2):54-56.e1. https://doi.org/10.5694/mja2.50674 - PubMed
  12. Lo Bianco G, Di Pietro S, Mazzuca E, Imburgia A, Tarantino L, Accurso G, Benenati V, Vernuccio F, Bucolo C, Salomone S, Riolo M (2020) Multidisciplinary approach to the diagnosis and in-hospital management of COVID-19 infection: a narrative review. Front Pharmacol 9(11):572168. https://doi.org/10.3389/fphar.2020.572168 - PubMed
  13. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, Henry TS, Kanne JP, Kligerman S, Ko JP, Litt H (2020) Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging 35(4):219–227. https://doi.org/10.1097/RTI.0000000000000524 - PubMed
  14. Pakray A, Walker D, Figacz A, Kilanowski S, Rhodes C, Doshi S, Coffey M (2020) Imaging evaluation of COVID-19 in the emergency department. Emerg Radiol 27(6):579–588. https://doi.org/10.1007/s10140-020-01787-0 - PubMed
  15. Vernuccio F, Giambelluca D, Cannella R, Lombardo FP, Panzuto F, Midiri M, Cabassa P (2020) Radiographic and chest CT imaging presentation and follow-up of COVID-19 pneumonia: a multicenter experience from an endemic area. Emerg Radiol 27(6):623–632. https://doi.org/10.1007/s10140-020-01817-x - PubMed
  16. Barbosa CS, Chaves GWOG, de Oliveira CV, Bachion GH, Chi CK, Cerri GG, Lima TC, Lee HJ (2020) COVID-19 pneumonia in the emergency department: correlation of initial chest CT findings with short-term outcome. Emerg Radiol 27(6):691–699. https://doi.org/10.1007/s10140-020-01863-5 - PubMed
  17. Mirza-Aghazadeh-Attari M, Zarrintan A, Nezami N, Mohammadi A, Zarrintan A, Mohebbi I, Pirnejad H, Khademvatani K, Ashkavand Z, Forughi P, Arasteh A, Attari JA (2020) Predictors of coronavirus disease 19 (COVID-19) pneumonitis outcome based on computed tomography (CT) imaging obtained prior to hospitalization: a retrospective study. Emerg Radiol 27(6):653–661. https://doi.org/10.1007/s10140-020-01833-x - PubMed
  18. Jajodia A, Ebner L, Heidinger B, Chaturvedi A, Prosch H (2020) Imaging in corona virus disease 2019 (COVID-19)-A Scoping review. Eur J Radiol Open 11(7):100237. https://doi.org/10.1016/j.ejro.2020.100237 - PubMed
  19. Sheard S, Rao P, Devaraj A (2012) Imaging of acute respiratory distress syndrome. Respir Care 57(4):607–612. https://doi.org/10.4187/respcare.01731 - PubMed
  20. Pan C, Chen L, Lu C, Zhang W, Xia JA, Sklar MC et al (2020) Lung recruitability in COVID-19–associated acute respiratory distress syndrome: a single-center observational study. Am J Respir Crit Care Med 201:1294–1297 - PubMed
  21. Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, PROSEVA Study Group et al (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168 - PubMed
  22. Franco C, Facciolongo N, Tonelli R, Dongilli R, Vianello A, Pisani L, Scala R, Malerba M, Carlucci A, Negri EA, Spoladore G, Arcaro G, Tillio PA, Lastoria C, Schifino G, Tabbì L, Guidelli L, Guaraldi G, Ranieri VM, Clini E, Nava S (2020) Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia. Eur Respir J 56(5):2002130. https://doi.org/10.1183/13993003.02130-2020 - PubMed
  23. Guy T, Créac’hcadec A, Ricordel C, Salé A, Arnouat B, Bizec JL, Langelot M, Lineau C, Marquette D, Martin F, Lederlin M, Jouneau S (2020) High-flow nasal oxygen: a safe, efficient treatment for COVID-19 patients not in an ICU. Eur Respir J 56(5):2001154. https://doi.org/10.1183/13993003.01154-2020 - PubMed
  24. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L (2020) COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med 46(6):1099–1102. https://doi.org/10.1007/s00134-020-06033-2 - PubMed
  25. Gange CP, Pahade JK, Cortopassi I, Bader AS, Bokhari J, Hoerner M, Thomas KM, Rubinowitz AN (2020) Social distancing with portable chest radiographs during the COVID-19 pandemic: assessment of radiograph technique and image quality obtained at 6 feet and through glass. Radiol Cardiothorac Imaging 2(6):e200420. https://doi.org/10.1148/ryct.2020200420 - PubMed
  26. McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, Thomas KM, Moore WH (2020) Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology 297(2):E252–E262. https://doi.org/10.1148/radiol.2020202352 - PubMed
  27. Gupta VK, Alkandari BM, Mohammed W, Tobar AM, Abdelmohsen MA (2020) Ventilator associated lung injury in severe COVID-19 pneumonia patients - case reports: ventilator associated lung injury in COVID-19. Eur J Radiol Open 9(8):100310. https://doi.org/10.1016/j.ejro.2020.100310 - PubMed
  28. Langlet B, Dournes G, Laurent F (2019) CT features of pulmonary interstitial emphysema. Diagn Interv Imaging 100(12):825–826. https://doi.org/10.1016/j.diii.2019.04.004 - PubMed
  29. Brito J, Gregório P, Mariani A, D’ambrosio P, Filho M, Ferreira L, Sawamura M, Pêgo-Fernandes PM (2021) Pneumomediastinum in COVID-19 disease: outcomes and relation to the Macklin effect. Asian Cardiovasc Thorac Ann 29(6):541–548. https://doi.org/10.1177/02184923211010089 - PubMed
  30. López Vega JM, Parra Gordo ML, DiezTascón A, Ossaba VS (2020) Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease. Emerg Radiol 27(6):727–730. https://doi.org/10.1007/s10140-020-01806-0 - PubMed
  31. Zylak CM, Standen JR, Barnes GR, Zylak CJ (2000) Pneumomediastinum revisited. Radiographics 20(4):1043–57. https://doi.org/10.1148/radiographics.20.4.g00jl131043 - PubMed
  32. Bejvan SM, Godwin JD (1996) Pneumomediastinum: old signs and new signs. AJR Am J Roentgenol 166(5):1041–1048. https://doi.org/10.2214/ajr.166.5.8615238 - PubMed
  33. Scacciavillani R, Iannaccone G, Buono MGD, Bello G (2020) Pneumopericardium following mechanical ventilation in COVID-19 pneumonia. Eur Heart J Case Rep 4(FI1):1–2. https://doi.org/10.1093/ehjcr/ytaa213 - PubMed
  34. Shennib HF, Barkun AN, Matouk E, Blundell PE (1988) Surgical decompression of a tension pneumomediastinum. A ventilatory complication of status asthmaticus. Chest 93(6):1301–2. https://doi.org/10.1378/chest.93.6.1301 - PubMed
  35. Galetin T, Defosse J, Schieren M, Marks B, Lopez-Pastorini A, Koryllos A, Kosse N, Wappler F, Stoelben E (2020) Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardiothorac Surg 57(5):846–853. https://doi.org/10.1093/ejcts/ezz332 - PubMed
  36. Tocino IM, Miller MH, Fairfax WR (1985) Distribution of pneumothorax in the supine and semirecumbent critically ill adult. AJR Am J Roentgenol 144(5):901–905. https://doi.org/10.2214/ajr.144.5.901 - PubMed
  37. Akdogan RE, Mohammed T, Syeda A, Jiwa N, Ibrahim O, Mutneja R (2021) Pneumothorax in mechanically ventilated patients with COVID-19 Infection. Case Rep Crit Care 2021:8. https://doi.org/10.1155/2021/6657533 (Article ID 6657533) - PubMed
  38. Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG (2021) Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother 27(6):826–833. https://doi.org/10.1016/j.jiac.2021.01.011 - PubMed
  39. Póvoa HCC, Chianca GC, Iorio NLPP (2020) COVID-19: an alert to ventilator-associated bacterial pneumonia. Infect Dis Ther 9(3):417–420. https://doi.org/10.1007/s40121-020-00306-5 - PubMed
  40. Borasio P, Ardissone F, Chiampo G (1997) Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg 12(1):98–100. https://doi.org/10.1016/s1010-7940(97)00111-5 - PubMed

Publication Types