Abstract
OBJECTIVE Nearly 5 % of the patients with COVID-19 develop an acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to controls and whether EVLWI has the potential to monitor disease progression.
METHODS From the day of intubation, EVLWI, cardiac function were monitored by transpulmonary thermodilution in n=25 patients with COVID-19 and compared to a control group of 49 non-COVID-19 ARDS-patients.
RESULTS EVLWI in COVID-19-patients was noticeably elevated and significantly higher than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p<0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p=0.003) suggest inflammatory oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and mortality (23.2±6.7% vs. 30.3±6.0%, p=0.025).
CONCLUSIONS Compared to the control group, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 associated ARDS and could serve as parameter to monitor ARDS progression.
Competing Interest Statement
Tobias Lahmer received travel grants from Gilead, Pfizer and MSD. Sebastian Rasch received travel grants from Gilead. Christoph Spinner collaborates with AbbVie, Gilead, Janssen-Cilag, MSD and ViiV Healthcare/GSK as member of the advisory board and received travel and study grants. Wolfgang Huber collaborated with Pulsion Medical Systems SE, Feldkirchen, Germany as member of the Medical Advisory Board. All other authors declare that there is no conflict of interest.
Clinical Trial
ISRCTN10077335
Funding Statement
No external funding was obtained for this study.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Ethics committee of Technical University of Munich; Approval No. 178/20S
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Yes
Data Availability
All data relevant for the analysis and conclusions of this study are included in this published article (and its Supplementary Information files). Exceeding information is available from the corresponding author on reasonable request.