key: cord-0832401-k9aomwdg
authors: Mostafa, Maha; Adolf Helmy, Mina; Magdy Milad, Lydia; Hasanin, Ahmed
title: Patient self-induced lung injury risk in severe COVID-19
date: 2021-12-31
journal: Anaesth Crit Care Pain Med
DOI: 10.1016/j.accpm.2021.101018
sha: b81fa40cb063147e530b955acb6e46f353d9a817
doc_id: 832401
cord_uid: k9aomwdg

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hypocapnia. Patients with P-SILI are at increased risk of progressive lung injury due to abnormal increase in transpulmonary pressure leading to baro-and volutrauma, and possibly negative pressure lung oedema. Hence, the authors suggest that early hypocapnia would be a sensitive predictor of the need for ventilatory support and/or poor patient outcomes.

In our current report concerning diaphragmatic excursion in patients with severe COVID-19 [2], we did not encounter any patient with exaggerated diaphragmatic function and the maximum diaphragmatic excursion was 45-and 37 mm in the right and left sides, respectively. In our earlier report, we evaluated diaphragmatic excursion at weaning from invasive mechanical ventilation; however, we did not assess the patients at hospital admission [3] .

Unfortunately, we did not record PaCO2 values during our two studies [2, 4] ; however, previous literature showed that patients with severe COVID-19 have lower inspiratory effort in comparison to matched non-COVID-19 cohort with respiratory failure, suggesting lower risk of P-SILI in patients with COVID-19 [4] . Furthermore, data from COVID-19 patients showed that PaCO2 was not significantly lower in patients who later needed mechanical ventilation, and that PaCO2 showed low accuracy in predicting the need for mechanical ventilation and/or death with area under receiver operating characteristic (95% confidence interval) of 0.57 (0.51 to 0.68) [5] . Thus, we suggest that the level of PaCO2 on hospital admission is unlikely a predictor of severity of the disease. However, we agree that direct comparison between the diaphragmatic excursion and PaCO2 level as risk predictors warrants further research.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors J o u r n a l P r e -p r o o f

Using PaCO2 as a sensitive information for detection of respiratory deterioration in severe Covid19 patients

The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019

Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19

Inspiratory effort and lung mechanics in spontaneously breathing patients with acute respiratory failure due to COVID-19: A matched control study

Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to Covid-19: A pilot prospective study