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13 pages, 2807 KiB

Open AccessArticle

The First Italian Telemedicine Program for Non-Critical COVID-19 Patients: Experience from Lodi (Italy)

by Sara Forlani, Erminia Mastrosimone, Stefano Paglia, Simonetta Protti, Maria Paola Ferraris, Maria Chiara Casale, Mirko Di Capua, Maria Giuseppina Grossi, Marco Esposti, Davide Randazzo and Davide Giustivi

J. Clin. Med. 2022, 11(18), 5322; https://doi.org/10.3390/jcm11185322 - 10 Sep 2022

Cited by 1 | Viewed by 1447

Abstract

Italy was the first Western country to face a massive SARS-CoV-2 outbreak. The limited information initially available on the natural course of the disease required caution in the discharge of patients accessing health facilities. This resulted in overcrowded health facilities and emergency services. [...] Read more.

Italy was the first Western country to face a massive SARS-CoV-2 outbreak. The limited information initially available on the natural course of the disease required caution in the discharge of patients accessing health facilities. This resulted in overcrowded health facilities and emergency services. In this context, improvements of other forms of hospital care assistance were needed. This study shows the results of the first Italian remote monitoring program for COVID-19 patients. The program was implemented by the Azienda Socio Sanitaria (ASST) Lodi (Italy) by using the innovative Zcare software^®. Data generated during patient recruitment, monitoring, and discharge were extracted from the Zcare software and statistically analysed. Data refer to a sample of 1196 patients enrolled in the remote monitoring program in 2020. Patients reported symptoms mainly during the first week. The most frequently reported symptoms were general fatigue, cough, and loss of taste and smell (dysosmia). More than 80% of patients reported a saturation level below 96% at least once, and more than 70% had a temperature above 37 °C. Active monitoring of reported symptoms provided valuable insights into the disease’s natural history during its less severe acute phase. Only 109 individuals visited the emergency department at least once in the first 100 days of monitoring. Of these, 101 had COVID-19 infection, 69 of whom were hospitalized following a first clinical assessment at the emergency department. The ASST Lodi’s telemedicine strategy for COVID patients appears to be a viable alternative to hospitalization. This strategy enables the provision of proper care while making resources available for more critically ill patients, and enhances the availability of resources available for more critically ill patients. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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12 pages, 7135 KiB

Open AccessArticle

Multidimensional 3-Month Follow-Up of Severe COVID-19: Airways beyond the Parenchyma in Symptomatic Patients

by Matteo Bonato, Piera Peditto, Nicholas Landini, Alessia Fraccaro, Cosimo Catino, Maria Cuzzola, Nicola Malacchini, Francesca Savoia, Nicola Roma, Mauro Salasnich, Martina Turrin, Francesca Zampieri, Giuseppe Zanardi, Fabiola Zeraj, Marcello Rattazzi, Mario Peta, Simonetta Baraldo, Marina Saetta, Michele Fusaro, Giovanni Morana and Micaela Romagnoli Show full author list Hide full author list

J. Clin. Med. 2022, 11(14), 4046; https://doi.org/10.3390/jcm11144046 - 13 Jul 2022

Cited by 7 | Viewed by 1247

Abstract

SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CT_H). Three months after being discharged, these patients were [...] Read more.

SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CT_H). Three months after being discharged, these patients were evaluated by a clinical examination, pulmonary function tests and a chest-CT scan (CT_FU). Sixty-two patients were enrolled. At follow-up, 27% complained of exertional dyspnoea and 12% of cough. Dyspnoeic patients had a lower forced expiratory flow (FEF)_25–75 (p = 0.015), while a CT scan (p = 0.016 showed that patients with cough had a higher extent of bronchiectasis. Lung volumes and diffusion of carbon monoxide (DLCO) at follow-up were lower in patients who had been invasively ventilated, which correlated inversely with the length of hospitalization and ground-glass extension at CT_H. At follow-up, 14.5% of patients had a complete radiological resolution, while 85.5% presented persistence of ground-glass opacities, and 46.7% showed fibrotic-like alterations. Residual ground-glass at CT_FU was related to the length of hospitalization (r = 0.48; p = 0.0002) and to the need for mechanical ventilation or high flow oxygen (p = 0.01) during the acute phase. In conclusion, although patients at three months from discharge showed functional impairment and radiological abnormalities, which correlated with a prolonged hospital stay and need for mechanical ventilation, the persistence of respiratory symptoms was related not to parenchymal but rather to airway sequelae. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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10 pages, 245 KiB

Open AccessArticle

Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19

by Kristen Grove, Dale W. Edgar, HuiJun Chih, Meg Harrold, Varsha Natarajan, Sheeraz Mohd, Elizabeth Hurn and Vinicius Cavalheri

J. Clin. Med. 2022, 11(13), 3602; https://doi.org/10.3390/jcm11133602 - 22 Jun 2022

Cited by 2 | Viewed by 1702

Abstract

↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected [...] Read more.

↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected COVID-19 was recruited. Participants were grouped according to their polymerase chain reaction (PCR) test result into COVID-19 positive (COVID+) and COVID-19 negative (COVID−) groups. Between-group comparisons of characteristics of the participants and hospital admission data were performed. Sixty-five participants were included (38 COVID+ and 27 COVID−; 36 females [55%]). Participants in the COVID+ group had greater acute hospital length of stay (LOS) (median [25–75th percentile] 10 [5–21] vs. 3 [2–5] days; p < 0.05] and only those with COVID+ required mechanical ventilation (8 [21%] participants). Twenty-one percent of the COVID+ participants were discharged to inpatient rehabilitation (7% of the COVID− participants). Of note, pre-existing pulmonary disease was more prevalent in the COVID− group (59% vs. 13%; p < 0.05). Within the COVID+ group, when compared to participants discharged home, those who required inpatient rehabilitation had worse peripheral oxygen saturation (SpO₂) on admission (86 ± 5.7% vs. 93 ± 3.8%; p < 0.05) and longer median LOS (30 [23–37] vs. 7 [4–13] days; p < 0.05). Despite having less people with pre-existing pulmonary disease, the COVID+ group required more care and rehabilitation than the COVID− group. In the COVID+ group, SpO₂ on hospital presentation was associated with LOS, critical care needs, mechanical ventilation duration and the need for inpatient rehabilitation. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

7 pages, 560 KiB

Open AccessArticle

Arrhythmias in COVID-19/SARS-CoV-2 Pneumonia Infection: Prevalence and Implication for Outcomes

by Andrea Denegri, Matteo Sola, Marianna Morelli, Francesco Farioli, Alberto Tosetti, Matteo D’Arienzo, Fulvio Savorani, Giuseppe Stefano Pezzuto, Giuseppe Boriani, Lukasz Szarpak and Giulia Magnani

J. Clin. Med. 2022, 11(5), 1463; https://doi.org/10.3390/jcm11051463 - 7 Mar 2022

Cited by 6 | Viewed by 1741

Abstract

Arrhythmias (ARs) are potential cardiovascular complication of COVID-19 but may also have a prognostic role. The aim of this study was to explore the prevalence and impact of cardiac ARs in hospitalized COVID-19 patients. All-comer patients admitted to the emergency department of Modena [...] Read more.

Arrhythmias (ARs) are potential cardiovascular complication of COVID-19 but may also have a prognostic role. The aim of this study was to explore the prevalence and impact of cardiac ARs in hospitalized COVID-19 patients. All-comer patients admitted to the emergency department of Modena University Hospital from 16 March to 31 December 2020 and diagnosed with COVID-19 pneumonia infection were included in the study. The primary endpoint was 30-day mortality. Out of 902 patients, 637 (70.6%) presented a baseline 12-lead ECG registration; of these, 122 (19.2%) were diagnosed with ARs. Atrial fibrillation (AF, 40.2%) was the most frequent AR detected. The primary endpoint (30-day mortality) occurred in 33.6% (p < 0.001). AR-patients presented an almost 3-fold risk of mortality compared to non-AR-patients at 30d (Adj. OR = 2.8, 95%CI: 1.8–4.3, p < 0.001). After adjustment for significant baseline characteristics selected by a stepwise backward selection, AR-patients remained at increased risk of mortality (Adj. HR = 2.0, 95%CI: 1.9–2.3, p < 0.001). Sub-group analysis revealed that among ARs patients, those with AF at admission presented the highest risk of 30-day mortality (Adj. HR = 3.1, 95%CI: 2.0–4.9, p < 0.001). In conclusion, ARs are a quite common manifestation in COVID-19 patients, who are burdened by even worse prognosis. AR patients with AF presented the highest risk of mortality; thus, these patients may benefit from a more aggressive secondary preventive therapy and a closer follow up. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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11 pages, 6161 KiB

Open AccessArticle

No Influence of Previous Coxiella burnetii Infection on ICU Admission and Mortality in Emergency Department Patients Infected with SARS-CoV-2

by Jesper M. Weehuizen, Rik van Spronsen, Andy I. M. Hoepelman, Chantal P. Bleeker-Rovers, Jan Jelrik Oosterheert and Peter C. Wever

J. Clin. Med. 2022, 11(3), 526; https://doi.org/10.3390/jcm11030526 - 20 Jan 2022

Cited by 1 | Viewed by 1552

Abstract

Background: the geographical similarities of the Dutch 2007–2010 Q fever outbreak and the start of the 2020 coronavirus disease 19 (COVID-19) outbreak in the Netherlands raised questions and provided a unique opportunity to study an association between Coxiella burnetii infection and the outcome [...] Read more.

Background: the geographical similarities of the Dutch 2007–2010 Q fever outbreak and the start of the 2020 coronavirus disease 19 (COVID-19) outbreak in the Netherlands raised questions and provided a unique opportunity to study an association between Coxiella burnetii infection and the outcome following SARS-CoV-2 infection. Methods: We performed a retrospective cohort study in two Dutch hospitals. We assessed evidence of previous C. burnetii infection in COVID-19 patients diagnosed at the ED during the first COVID-19 wave and compared a combined outcome of in-hospital mortality and intensive care unit (ICU) admission using adjusted odds ratios (OR). Results: In total, 629 patients were included with a mean age of 68.0 years. Evidence of previous C. burnetii infection was found in 117 patients (18.6%). The combined primary outcome occurred in 40.2% and 40.4% of patients with and without evidence of previous C. burnetii infection respectively (adjusted OR of 0.926 (95% CI 0.605–1.416)). The adjusted OR of the secondary outcomes in-hospital mortality, ICU-admission and regular ward admission did not show an association either. Conclusion: no influence of previous C. burnetii infection on the risk of ICU admission and/or mortality for patients with COVID-19 presenting at the ED was observed. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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10 pages, 586 KiB

Open AccessArticle

Remote Hospital Care for Recovering COVID-19 Patients Using Telemedicine: A Randomised Controlled Trial

by Harriët M. R. van Goor, Martine J. M. Breteler, Kim van Loon, Titus A. P. de Hond, Johannes B. Reitsma, Dorien L. M. Zwart, Cornelis J. Kalkman and Karin A. H. Kaasjager

J. Clin. Med. 2021, 10(24), 5940; https://doi.org/10.3390/jcm10245940 - 17 Dec 2021

Cited by 12 | Viewed by 2701

Abstract

Background: To ensure availability of hospital beds and improve COVID-19 patients’ well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, [...] Read more.

Background: To ensure availability of hospital beds and improve COVID-19 patients’ well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, but the beneficial effect has yet to be established. Methods: We conducted a single centre, randomised trial from January to June 2021, including hospitalised COVID-19 patients who were in the recovery stage of the disease. Hospital care for the intervention group was transitioned to the patient’s home, including oxygen therapy, medication and remote monitoring. The control group received in-hospital care as usual. The primary endpoint was the number of hospital-free days during the 30 days following randomisation. Secondary endpoints included health care consumption during the follow-up period and mortality. Results: A total of 62 patients were randomised (31 control, 31 intervention). The mean difference in hospital-free days was 1.7 (26.7 control vs. 28.4 intervention, 95% CI of difference −0.5 to 4.2, p = 0.112). In the intervention group, the index hospital length of stay was 1.6 days shorter (95% CI −2.4 to −0.8, p < 0.001), but the total duration of care under hospital responsibility was 4.1 days longer (95% CI 0.5 to 7.7, p = 0.028). Conclusion: Remote hospital care for recovering COVID-19 patients is feasible. However, we could not demonstrate an increase in hospital-free days in the 30 days following randomisation. Optimising the intervention, timing, and identification of patients who will benefit most from remote hospital care could improve the impact of this intervention. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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10 pages, 947 KiB

Open AccessArticle

Riding the COVID Waves: Clinical Trends, Outcomes, and Remaining Pitfalls of the SARS-CoV-2 Pandemic: An Analysis of Two High-Incidence Periods at a Hospital in Northern Italy

by Marina Sartini, Filippo Del Puente, Martino Oliva, Alessio Carbone, Elisabetta Blasi Vacca, Andrea Parisini, Silvia Boni, Nicoletta Bobbio, Marcello Feasi, Alessandra Battistella, Emanuele Pontali and Maria Luisa Cristina

J. Clin. Med. 2021, 10(22), 5239; https://doi.org/10.3390/jcm10225239 - 11 Nov 2021

Cited by 6 | Viewed by 1954

Abstract

Background. Italy was the first western country to face an uncontrolled outbreak of SARS-CoV-2 infection. The epidemic began in March 2020 within a context characterised by a general lack of knowledge about the disease. The first scientific evidence emerged months later, leading to [...] Read more.

Background. Italy was the first western country to face an uncontrolled outbreak of SARS-CoV-2 infection. The epidemic began in March 2020 within a context characterised by a general lack of knowledge about the disease. The first scientific evidence emerged months later, leading to treatment changes. The aim of our study was to evaluate the effects of these changes. Methods. Data from a hospital in Genoa, Italy, were analysed. Patients deceased from SARS-CoV-2 infection were selected. Data were compared by dividing patients into two cohorts: “phase A” (March–May 2020) and “phase B” (October–December 2020). Results. A total of 5142 patients were admitted. There were 274 SARS-CoV-2-related deaths (162 phase A and 112 phase B). No differences were observed in terms of demographics, presentation, or comorbidities. A significant increase was recorded in corticosteroid use. Mortality was 33.36% during phase A, falling to 21.71% during phase B. When subdividing the trend during the two phases by age, we found a difference in people aged 65–74 years. Conclusions. There is scarce evidence regarding treatment for SARS-CoV-2 (especially for severe infection). However, treatment changes improved the prognosis for people under the age of 75. The prognosis for older people remains poor, despite the improvements achieved. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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10 pages, 974 KiB

Open AccessArticle

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

by Matteo Bonato, Alessia Fraccaro, Nicholas Landini, Giuseppe Zanardi, Cosimo Catino, Francesca Savoia, Nicola Malacchini, Fabiola Zeraj, Piera Peditto, Vito Catalanotti, Elisabetta Marcon, Emanuela Rossi, Alessia Pauletti, Silvia Galvan, Riccardo Adami, Marta Tiepolo, Mauro Salasnich, Maria Cuzzola, Francesca Zampieri, Marcello Rattazzi, Mario Peta, Simonetta Baraldo, Marina Saetta, Giovanni Morana and Micaela Romagnoli Show full author list Hide full author list

J. Clin. Med. 2021, 10(21), 4835; https://doi.org/10.3390/jcm10214835 - 21 Oct 2021

Cited by 14 | Viewed by 2108

Abstract

Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis [...] Read more.

Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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12 pages, 901 KiB

Open AccessArticle

Role of Nucleocapsid Protein Antigen Detection for Safe End of Isolation of SARS-CoV-2 Infected Patients with Long Persistence of Viral RNA in Respiratory Samples

by Antonella Mencacci, Alessio Gili, Anna Gidari, Elisabetta Schiaroli, Carla Russo, Elio Cenci, Barbara Camilloni, Alessandro Graziani, Arduino Melelli-Roia, Daniela Francisci and Fabrizio Stracci

J. Clin. Med. 2021, 10(18), 4037; https://doi.org/10.3390/jcm10184037 - 7 Sep 2021

Cited by 6 | Viewed by 2299

Abstract

Background. In SARS-CoV-2 infection, viral RNA may persist in respiratory samples for several weeks after the resolution of symptoms. Criteria to assess the end of infectivity are not unequivocally defined. In some countries, time from diagnosis is the unique criterion used, in addition [...] Read more.

Background. In SARS-CoV-2 infection, viral RNA may persist in respiratory samples for several weeks after the resolution of symptoms. Criteria to assess the end of infectivity are not unequivocally defined. In some countries, time from diagnosis is the unique criterion used, in addition to symptom cessation. This study evaluates the role of the Lumipulse^® Antigen Assay (LAA) for the safe end of isolation of patients ≥21 days after the diagnosis of infection. Methods. A total of 671 nasopharyngeal swabs from patients diagnosed with infection at least 21 days before were assessed by RT-PCR and LAA, and the role of LAA in predicting the absence of infectivity was evaluated by virus cell culture. Results. Viable virus was present in 10/138 cultured samples. Eight out of ten infective patients suffered from a concomitant disease, predisposing them to long-term shedding of infective virus. In particular, infectious virus was isolated from 10/20 RT-PCR+/LAA+ cultured samples, whereas no viable virus was found in all 118 RT-PCR+/LAA– cultured swabs. LLA and RT-PCR agreed in 484/671 (72.1%) samples, with 100% and 26.7% concordance in RT-PCR negative and positive samples, respectively. Conclusions. Viable virus can be found ≥21 days after diagnosis in immunocompromised or severely ill patients. LAA better than RT-PCR predicts non-infectivity of patients and can be safely used to end isolation in cases with long persistence of viral RNA in the respiratory tract. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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8 pages, 905 KiB

Open AccessArticle

Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy

by Andrea Vianello, Martina Turrin, Gabriella Guarnieri, Beatrice Molena, Giovanna Arcaro, Cristian Turato, Fausto Braccioni, Leonardo Bertagna De Marchi, Federico Lionello, Pavle Subotic, Stefano Masiero, Chiara Giraudo and Paolo Navalesi

J. Clin. Med. 2021, 10(15), 3404; https://doi.org/10.3390/jcm10153404 - 30 Jul 2021

Cited by 9 | Viewed by 2713

Abstract

Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O₂-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims [...] Read more.

Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O₂-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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12 pages, 1709 KiB

Open AccessArticle

Compromised Lung Volume and Hemostatic Abnormalities in COVID-19 Pneumonia: Results from an Observational Study on 510 Consecutive Patients

by Ezio Lanza, Maria Elisa Mancuso, Gaia Messana, Paola Ferrazzi, Costanza Lisi, Pierpaolo Di Micco, Stefano Barco, Luca Balzarini and Corrado Lodigiani

J. Clin. Med. 2021, 10(13), 2894; https://doi.org/10.3390/jcm10132894 - 29 Jun 2021

Cited by 2 | Viewed by 1781

Abstract

Background: Hemostatic abnormalities have been described in COVID-19, and pulmonary microthrombosis was consistently found at autopsy with concomitant severe lung damage. Methods: This is a retrospective observational cross-sectional study including consecutive patients with COVID-19 pneumonia who underwent unenhanced chest CT upon admittance at [...] Read more.

Background: Hemostatic abnormalities have been described in COVID-19, and pulmonary microthrombosis was consistently found at autopsy with concomitant severe lung damage. Methods: This is a retrospective observational cross-sectional study including consecutive patients with COVID-19 pneumonia who underwent unenhanced chest CT upon admittance at the emergency room (ER) in one large academic hospital. QCT was used for the calculation of compromised lung volume (%CL). Clinical data were retrieved from patients’ files. Laboratory data were obtained upon presentation at the ER. Aim: The aim of this study was to evaluate the correlation between hemostatic abnormalities and lung involvement in patients affected by COVID-19 pneumonia as described using computer-aided quantitative evaluation of chest CT (quantitative CT (QCT)). Results: A total of 510 consecutive patients (68% males), aged 67 years in median, diagnosed with COVID-19 pneumonia, who underwent unenhanced CT scan upon admission to the ER, were included. In all, 115 patients had %CL > 23%; compared to those with %CL < 23%, they showed higher levels of D-dimer, fibrinogen, and CRP, greater platelet count, and longer PT ratio. Via multivariate regression analysis, BMI ≥ 30 kg/m², D-dimer levels > 500 ng/mL, CRP > 5.0 ng/mL and PT ratio > 1.2 were found to be independent predictors of a %CL > 23% (adjusted odds ratios (95% confidence intervals): 2.1 (1.1–4.0), 3.1 (1.6–5.8), 2.4 (1.3–4.5), and 3.4 (1.4–8.5), respectively). Conclusions: Hemostatic abnormalities in patients affected by COVID-19 correlate with the severity of lung injury as measured by %CL. Our results underline the pathogenetic role of hemostasis in COVID-19 pneumonia beyond the presence of clinically evident thromboembolic complications. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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7 pages, 866 KiB

Open AccessReview

Respiratory Monitoring at Bedside in COVID-19 Patients

by Davide Giustivi, Francesco Bottazzini and Mirko Belliato

J. Clin. Med. 2021, 10(21), 4943; https://doi.org/10.3390/jcm10214943 - 26 Oct 2021

Cited by 6 | Viewed by 2871

Abstract

The SARS-CoV-2 (COVID-19) pandemic has forced some reflections to be had surrounding the ventilatory support to be applied to certain types of patients. The model of two phenotypes, set out by Professor Gattinoni and colleagues, suggests that adequate monitoring of respiratory effort may [...] Read more.

The SARS-CoV-2 (COVID-19) pandemic has forced some reflections to be had surrounding the ventilatory support to be applied to certain types of patients. The model of two phenotypes, set out by Professor Gattinoni and colleagues, suggests that adequate monitoring of respiratory effort may play a key role in the treatment of respiratory failure due to COVID-19. An insufficient control of the patient’s respiratory efforts could lead to an aggravation of lung damage, mainly due to the possibility of generating Patient Self-Inflicted Lung Injury (PSILI) with a consequent aggravation of the pathological picture. Nevertheless, effectively monitoring the patient’s respiratory work, especially in nonintensive settings, is not easy. This article briefly describes some methods that allow the assessment of respiratory effort, such as the use of ultrasound and respiratory tests, which can be performed in nonintensive settings. Full article

(This article belongs to the Special Issue Recent Updates in the Management of Pneumonia and COVID-19)

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