RT Journal Article
SR Electronic
T1 COVID-19 pneumonia: pathophysiology and management
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 210138
DO 10.1183/16000617.0138-2021
VO 30
IS 162
A1 Gattinoni, Luciano
A1 Gattarello, Simone
A1 Steinberg, Irene
A1 Busana, Mattia
A1 Palermo, Paola
A1 Lazzari, Stefano
A1 Romitti, Federica
A1 Quintel, Michael
A1 Meissner, Konrad
A1 Marini, John J.
A1 Chiumello, Davide
A1 Camporota, Luigi
YR 2021
UL http://err.ersjournals.com/content/30/162/210138.abstract
AB Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. The underlying mechanism is primarily altered lung perfusion. The anatomical prerequisites for PEEP (positive end-expiratory pressure) to work (lung oedema, atelectasis, and therefore recruitability) are lacking. In the high-dependency unit: the disease starts to worsen either because of its natural evolution or additional patient self-inflicted lung injury (P-SILI). Oedema and atelectasis may develop, increasing recruitability. Noninvasive supports are indicated if they result in a reversal of hypoxaemia and a decreased inspiratory effort. Otherwise, mechanical ventilation should be considered to avert P-SILI. In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift from oedema or atelectasis to less reversible structural lung alterations to lung fibrosis. These later characteristics are associated with notable impairment of respiratory mechanics, increased arterial carbon dioxide tension (PaCO2), decreased recruitability and lack of response to PEEP and prone positioning.COVID-19 pneumonia cannot be correctly described, analysed and treated if the time-factor is not taken into account https://bit.ly/3AOKxc4