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Assessment of Pulmonary Vasculature Using Functional Respiratory Imaging

De Backer J.

Respiratory Drug Delivery 2021. Volume , 2021: 7-14.

Abstract:

The COVID-19 pandemic has made the need for respiratory innovation painfully clear. The current diagnostic tools did not allow physicians to have a good understanding of the disease, likely contributing to a near collapse of the healthcare system and a disproportionate death rate, especially in ventilated patients. This paper discusses the use of Functional Respiratory Imaging (FRI) and in particular the quantification of the regional pulmonary vasculature using conventional High-Resolution Computed Tomography (HRCT) scans. Early on in the pandemic, pulmonary vasculature was shown to be abnormal in COVID-19 patients hinting at inefficient blood flow due to endothelial damage in the microvasculature. The latter was later confirmed in autopsy studies. The findings proved to be clinically relevant in understanding how high thoracic pressures in ventilated patients could exacerbate rather than mitigate the situation, partially explaining the elevated death rate. Subsequent large clinical studies demonstrated the power of a pulmonary vasculature endpoint to predict intubation and death, opening the door to using the parameter as a tool to assist in triaging patients. Finally, the pulmonary vasculature remains abnormal in so-called Long COVID-19 (Long-Haul) patients for several months. As Long COVID-19 will continue to burden the healthcare system for the foreseeable future, it is important to continue and expand the use of novel technology to better understand and treat all aspects of COVID-19.