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Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome...
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Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 30649

Special Issue Editors

Prof. Marcus J. Schultz

E-Mail Website
Guest Editor
Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anesthesiol, NL-1105 AZ Amsterdam, Netherlands
Interests: lung injury; acute respiratory distress syndrome (ALI/ARDS); pneumonia and mechanical ventilation
Dr. Lorenzo Ball

E-Mail Website
Guest Editor
Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, 16126 Genova, GE, Italy
Interests: intensive care; critical care; anaesthesiology; lung imaging; respiratory physiology

Special Issue Information

Dear Colleagues,

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed unprecedented challenges for the clinicians involved in the management of intermediate and intensive care unit patients.
Hospitalized COVID-19 patients typically require oxygen therapy, and a certain proportion also require non-invasive or invasive respiratory support. Patients with severe COVID-19 typically meet the Berlin criteria for ARDS. However, analogies and differences have been hypothesized and observed between ARDS resulting from other causes and ARDS induced by COVID-19.
This Special Issue will consider original research papers, research letters, reviews, meta-analyses and editorials concerning the recent advances and current controversies in the management of severe COVID-19 patients, with particular regard to those who need mechanical ventilation.

Prof. Marcus J. Schultz
Dr. Lorenzo Ball
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ARDS
  • COVID-19
  • intensive care
  • respiratory failure
  • SARS-CoV-2

Published Papers (6 papers)

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Research

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9 pages, 216 KiB  
Article
Coronavirus Pneumonia: Outcomes and Characteristics of Patients in an Inner-City Area after 3 Months of Infection
by Gilda Diaz-Fuentes, Gabriella Roa-Gomez, Olga Reyes, Ravish Singhal and Sindhaghatta Venkatram
J. Clin. Med. 2021, 10(15), 3368; https://doi.org/10.3390/jcm10153368 - 29 Jul 2021
Cited by 3 | Viewed by 1537
Abstract
Background: The morbidity and long term pulmonary consequences of COVID-19 infection continue to unfold as we learn and follow survivors of this disease. We report radiological evolution and pulmonary function findings in those patients. Methods: This was a retrospective cohort study of adult [...] Read more.
Background: The morbidity and long term pulmonary consequences of COVID-19 infection continue to unfold as we learn and follow survivors of this disease. We report radiological evolution and pulmonary function findings in those patients. Methods: This was a retrospective cohort study of adult patients referred to the post-acute COVID-19 pulmonary clinic after a diagnosis of COVID-19 pneumonia. The study period was after the initial peak of the pandemic in New York City, from June to December 2020. Results: 111 patients were included. The average interval time between COVID-19 pneumonia and initial clinic evaluation was 12 weeks. 48.2% of patients had moderate and 22.3% had severe infection. Dyspnea and cough was the most common respiratory symptoms post infection. Radiographic abnormalities improved in majority of patients with ground glass opacities been the common residual abnormal finding. Restrictive airway disease and decreased diffusion capacity were the most common findings in pulmonary function test. Conclusion: Our study suggests the needs for close and serial monitoring of functional and radiological abnormalities during the post COVID-19 period. Considering that many of the clinical-radiological and functional abnormalities are reversible, we suggest a “wait and watch“approach to avoid unnecessary invasive work up. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
12 pages, 1857 KiB  
Article
An Experimental Pre-Post Study on the Efficacy of Respiratory Physiotherapy in Severe Critically III COVID-19 Patients
by Denise Battaglini, Salvatore Caiffa, Giovanni Gasti, Elena Ciaravolo, Chiara Robba, Jacob Herrmann, Sarah E. Gerard, Matteo Bassetti, Paolo Pelosi, Lorenzo Ball and on behalf of the GECOVID Group
J. Clin. Med. 2021, 10(10), 2139; https://doi.org/10.3390/jcm10102139 - 15 May 2021
Cited by 11 | Viewed by 4949
Abstract
Background: Respiratory physiotherapy (RPT) is considered essential in patients’ management during intensive care unit (ICU) stay. The role of RPT in critically ill COVID-19 patients is poorly described. We aimed to investigate the effects of RPT on oxygenation and lung aeration in [...] Read more.
Background: Respiratory physiotherapy (RPT) is considered essential in patients’ management during intensive care unit (ICU) stay. The role of RPT in critically ill COVID-19 patients is poorly described. We aimed to investigate the effects of RPT on oxygenation and lung aeration in critically ill COVID-19 patients admitted to the ICU. Methods: Observational pre-post study. Patients with severe COVID-19 admitted to the ICU, who received a protocolized CPT session and for which a pre-and post-RPT lung ultrasound (LUS) was performed, were included. A subgroup of patients had an available quantitative computed tomography (CT) scan performed within 4 days from RPT. The primary aim was to evaluate whether RPT improved oxygenation; secondary aims included correlations between LUS, CT and response to RPT. Results: Twenty patients were included. The median (1st–3rd quartile) PaO2/FiO2 was 181 (105–456), 244 (137–497) and 246 (137–482) at baseline (T0), after RPT (T1), and after 6 h (T2), respectively. PaO2/FiO2 improved throughout the study (p = 0.042); particularly, PaO2/FiO2 improved at T1 in respect to T0 (p = 0.011), remaining higher at T2 (p = 0.007) compared to T0. Correlations between LUS, volume of gas (rho = 0.58, 95%CI 0.05–0.85, p = 0.033) and hyper-aerated mass at CT scan (rho = 0.54, 95% CI 0.00–0.84, p = 0.045) were detected. No significant changes in LUS score were observed before and after RPT. Conclusions: RPT improved oxygenation and the improvement persisted after 6 h. Oxygenation improvement was not reflected by aeration changes assessed with LUS. Further studies are warranted to assess the efficacy of RPT in COVID-19 ICU patients. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
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14 pages, 1183 KiB  
Article
Associations of Body Mass Index with Ventilation Management and Clinical Outcomes in Invasively Ventilated Patients with ARDS Related to COVID-19—Insights from the PRoVENT-COVID Study
by Renée Schavemaker, Marcus J. Schultz, Wim K. Lagrand, Eline R. van Slobbe-Bijlsma, Ary Serpa Neto, Frederique Paulus, for the PRoVENT–COVID and Collaborative Group
J. Clin. Med. 2021, 10(6), 1176; https://doi.org/10.3390/jcm10061176 - 11 Mar 2021
Cited by 17 | Viewed by 7774
Abstract
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a [...] Read more.
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end–expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal–weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study: 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient’s BMI should not be used in decisions to forgo or proceed with invasive ventilation. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
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Review

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0 pages, 2718 KiB  
Review
Anticoagulant Treatment in Severe ARDS COVID-19 Patients
by Adrian Ceccato, Marta Camprubí-Rimblas, Elena Campaña-Duel, Aina Areny-Balagueró, Luis Morales-Quinteros and Antonio Artigas
J. Clin. Med. 2022, 11(10), 2695; https://doi.org/10.3390/jcm11102695 - 10 May 2022
Cited by 5 | Viewed by 2048
Abstract
Patients with COVID-19 may complicate their evolution with thromboembolic events. Incidence of thromboembolic complications are high and also, patients with the critically-ill disease showed evidence of microthrombi and microangiopathy in the lung probably due to endothelial damage by directly and indirectly injured endothelial [...] Read more.
Patients with COVID-19 may complicate their evolution with thromboembolic events. Incidence of thromboembolic complications are high and also, patients with the critically-ill disease showed evidence of microthrombi and microangiopathy in the lung probably due to endothelial damage by directly and indirectly injured endothelial and epithelial cells. Pulmonary embolism, deep venous thrombosis and arterial embolism were reported in patients with COVID-19, and several analytical abnormal coagulation parameters have been described as well. D-dimer, longer coagulation times and lower platelet counts have been associated with poor outcomes. The use of anticoagulation or high doses of prophylactic heparin is controversial. Despite the use of anticoagulation or high prophylactic dose of heparin have been associated with better outcomes in observational studies, only in patients with non-critically ill disease benefits for anticoagulation was observed. In critically-ill patient, anticoagulation was not associated with better outcomes. Other measures such as antiplatelet therapy, fibrinolytic therapy or nebulized anticoagulants are being studied in ongoing clinical trials. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
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11 pages, 3419 KiB  
Review
Fragility Index and Fragility Quotient in Randomized Controlled Trials on Corticosteroids in ARDS Due to COVID-19 and Non-COVID-19 Etiology
by Maria Vargas, Annachiara Marra, Pasquale Buonanno, Antonio Coviello, Carmine Iacovazzo and Giuseppe Servillo
J. Clin. Med. 2021, 10(22), 5287; https://doi.org/10.3390/jcm10225287 - 14 Nov 2021
Cited by 5 | Viewed by 4620
Abstract
Background: The effectiveness of corticosteroids in acute respiratory distress syndrome (ARDS) and COVID-19 still remains uncertain. Since ARDS is due to a hyperinflammatory response to a direct injury, we decided to perform a meta-analysis and an evaluation of robustness of randomised clinical trials [...] Read more.
Background: The effectiveness of corticosteroids in acute respiratory distress syndrome (ARDS) and COVID-19 still remains uncertain. Since ARDS is due to a hyperinflammatory response to a direct injury, we decided to perform a meta-analysis and an evaluation of robustness of randomised clinical trials (RCTs) investigating the impact of corticosteroids on mortality in ARDS in both COVID-19 and non-COVID-19 patients. We conducted a systematic search of the literature from inception up to 30 October 2020, using the MEDLINE database and the PubMed interface. We evaluated the fragility index (FI) of the included RCTs using a two-by-two contingency table and the p-value produced by the Fisher exact test; the fragility quotient (FQ) was calculated by dividing the FI score by the total sample size of the trial. Results: Thirteen RCTs were included in the analysis; five of them were conducted in COVID-19 ARDS, including 7692 patients, while 8 RCTS were performed in non-COVID ARDS with 1091 patients evaluated. Three out of eight RCTs in ARDS had a FI > 0 while 2 RCTs out of five in COVID-19 had FI > 0. The median of FI for ARDS was 0.625 (0.47) while the median of FQ was 0.03 (0.014). The median of FI for COVID-19 was 6 (2) while the median of FQ was 0.059 (0.055). In this systematic review, we found that FI and FQ of RCTs evaluating the use of corticosteroids in ARDS and COVID-19 were low. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
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12 pages, 1046 KiB  
Review
Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario
by Roberto Tonelli, Alessandro Marchioni, Luca Tabbì, Riccardo Fantini, Stefano Busani, Ivana Castaniere, Dario Andrisani, Filippo Gozzi, Giulia Bruzzi, Linda Manicardi, Jacopo Demurtas, Alessandro Andreani, Gaia Francesca Cappiello, Anna Valeria Samarelli and Enrico Clini
J. Clin. Med. 2021, 10(5), 975; https://doi.org/10.3390/jcm10050975 - 2 Mar 2021
Cited by 30 | Viewed by 8361
Abstract
The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual’s excessive [...] Read more.
The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual’s excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type. Full article
(This article belongs to the Special Issue Current Advances and Controversies in Severe Acute Respiratory Distress Syndrome from COVID-19)
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