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