Pneumology - Original Articles Open access

Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up

Authors

Published
19 January 2022
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2022.2142

Abstract

The correct type and time of follow-up for patients affected by COVID-19 ARDS is still unclear. The aim of this study was to evaluate the survivors of COVID-19 ARDS requiring non-invasive respiratory support (NRS) admitted to a Respiratory Intensive care unit (RICU) from March 8th till May 31st 2020 looking at all sequelae via a comprehensive follow up. All patients underwent a multi-disciplinary instrumental and clinical assessment within three months form admission to evaluate all infection related sequelae. Thirty-eight patients were enrolled lung-ultrasound (LUS) showed an outstanding discrimination ability (ROC AUC: 0.95) and a substantial agreement rate (Cohen’s K: 0.74) compared to chest CT-scan detecting improvement of lung consolidations. Youden’s test showed a cut-off pressure of 11 cm H2O ExpiratoryPAP-continuous-PAP-max (EPAP-CPAP) applied at the airways during hospitalization to be significantly correlated (p-value=0.026) to the increased pulmonary artery common trunk diameter. A total of 8/38 patients (21.8%), 2 of whom during follow-up, were diagnosed with pulmonary emboli (PE) and started anticoagulant treatment. Patients with PE had a statistically significant shorter length of time of hospitalization, time to negative swab, CPAP/NIV duration, P/F ratio and D-dimers at follow-up compared to non-PE. A comprehensive approach to patients with ARDS COVID-19 requiring NRS is necessary. This study highlighted cardiopulmonary impairment related to the ARDS and to the high-EPAP-CPAP-max greater than 11 mmHg provided during admission, the usefulness of LUS in monitoring post-infection recovery and the correct identification and treatment of patients with PE during follow up. 

Keywords

References

  1. Johns Hopkins University [Internet]. COVID-19 dashboard by the centre for systems science and engineering (CSSE) at, accessed November, 10, 2020. Available at: https://coronavirus.jhu.edu/map.html
  2. Gattinoni L, Coppola S, Cressoni M, et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med 2020;201:1299-300. DOI: https://doi.org/10.1164/rccm.202003-0817LE
  3. Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020;323:2329-30. DOI: https://doi.org/10.1001/jama.2020.6825
  4. Liu Y, Chen D, Hou J, et al. An inter-correlated cytokine network identified at the center of cytokine storm predicted COVID-19 prognosis. Cytokine 2021;138:155365. DOI: https://doi.org/10.1016/j.cyto.2020.155365
  5. Carsana L, Sonzogni A, Nasr A, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis 2020;20:1135-40. DOI: https://doi.org/10.1016/S1473-3099(20)30434-5
  6. Fox SE, Akmatbekov A, Harbert JL, et al. Pulmonary and cardiac pathology in COVID-19: the first autopsy series from New Orleans; medRxiv 2020;200:505-75. DOI: https://doi.org/10.1101/2020.04.06.20050575
  7. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med 2020;173:1030. DOI: https://doi.org/10.7326/L20-1206
  8. Mui LW, Lau JF, Lee HK. Thromboembolic complications of COVID-19. Emerg Radiol 2021;28:423-9. DOI: https://doi.org/10.1007/s10140-020-01868-0
  9. Di Lecce V, Carpagnano GE, Pierucci P, et al. Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy. Multidiscip Respir Med 2020;15:704. DOI: https://doi.org/10.4081/mrm.2020.704
  10. Pierucci P, Ambrosino N, Di Lecce V, et al. Prolonged active prone positioning in spontaneously breathing non-intubated patients with COVID-19-Associated hypoxemic acute respiratory failure with PaO2/FiO2>150. Front Med 2021;8:626321. DOI: https://doi.org/10.3389/fmed.2021.626321
  11. Winck JC, Ambrosino N. COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology 2020;26:213-20. DOI: https://doi.org/10.1016/j.pulmoe.2020.04.013
  12. Nadkarni GN, Lala A, Bagiella E, et al. Anticoagulation, bleeding, mortality and pathology in hospitalized patients with COVID-19. J Am Coll Cardiol 2020;76:1815-26. DOI: https://doi.org/10.1016/j.jacc.2020.08.041
  13. Spruit MA, Holland AE, Singh SJ, et al. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a european respiratory society and american thoracic society-coordinated international task force. Eur Respir J 2020;56:2002197. DOI: https://doi.org/10.1183/13993003.02197-2020
  14. Liang L, Yang B, Jiang N, et al. Three-month follow-up study of survivors of Coronavirus Disease 2019 after discharge. J Korean Med Sci 2020;35:e418. DOI: https://doi.org/10.3346/jkms.2020.35.e418
  15. Anastasio F, Barbuto S, Scarnecchia E, et al. Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life. Eur Respir J 2021;58:2004015. DOI: https://doi.org/10.1183/13993003.04015-2020
  16. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220-32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
  17. Udwadia ZF, Koul PA, Richeldi L. Post-COVID lung fibrosis: The tsunami that will follow the earthquake. Lung India 2021;38:S41-7. DOI: https://doi.org/10.4103/lungindia.lungindia_818_20
  18. Raghu G, Wilson KC. COVID-19 interstitial pneumonia: monitoring the clinical course in survivors. Lancet Respir Med 2020;8:839-42. DOI: https://doi.org/10.1016/S2213-2600(20)30349-0
  19. Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X, et al. Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology 2021;27:328-37. DOI: https://doi.org/10.1016/j.pulmoe.2020.10.013
  20. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54:1901647. DOI: https://doi.org/10.1183/13993003.01647-2019
  21. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 2011;124:1973-81. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.015008
  22. De Michele L, Pierucci P, Carpagnano GE, et al. Late unexpected consequences of COVID-19 infection in survivors of acute hypoxic respiratory failure. Intern Med J 2021;51:1363-4. DOI: https://doi.org/10.1111/imj.15261
  23. Wambier CG, Vaño-Galván S, McCoy J, et al. Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The "Gabrin sign". J Am Acad Dermatol 2020;83:680-2. DOI: https://doi.org/10.1016/j.jaad.2020.05.079
  24. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016;37:67-119. DOI: https://doi.org/10.1093/eurheartj/ehv317
  25. Soldati G, Smargiassi A, Inchingolo R, et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: a simple, quantitative, reproducible method. J Ultrasound Med 2020;39:1413-9. DOI: https://doi.org/10.1002/jum.15285
  26. Peng QY, Wang XT, Zhang LN, Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med 2020;46:849-50. DOI: https://doi.org/10.1007/s00134-020-05996-6
  27. Carlucci A, Paneroni M, Carotenuto M, et al. Prevalence of exercise-induced oxygen desaturation after recovery from SARS-CoV-2 pneumonia and use of lung ultrasound to predict need for pulmonary rehabilitation. Pulmonology 2021;S2531-0437(21)00117-3. Online ahead of print DOI: https://doi.org/10.1016/j.pulmoe.2021.05.008
  28. Simonelli C, Paneroni M, Vitacca M, Ambrosino N. Measures of physical performance in COVID-19 patients: a mapping review. Pulmonology 2021;27:518-28. DOI: https://doi.org/10.1016/j.pulmoe.2021.06.005
  29. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med 2003;167:1287. DOI: https://doi.org/10.1164/ajrccm.167.9.950
  30. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-26. Erratum in Eur Heart J 2021;42:4901. DOI: https://doi.org/10.1093/eurheartj/ehab670
  31. Scardapane A, Villani L, Bavaro DF, et al. Pulmonary artery filling defects in COVID-19 patients revealed using CT pulmonary angiography: a predictable complication? Biomed Res Int 2021;2021:8851736. DOI: https://doi.org/10.1155/2021/8851736
  32. Giovannetti G, De Michele L, De Ceglie M, et al. Lung ultrasonography for long-term follow-up of COVID-19 survivors compared to chest CT scan. Respir Med 2021;181:106384. DOI: https://doi.org/10.1016/j.rmed.2021.106384
  33. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J 2020;41:1858. DOI: https://doi.org/10.1093/eurheartj/ehaa254
  34. Bavaro DF, Poliseno M, Scardapane A, et al. Occurrence of acute pulmonary embolism in COVID-19, a case series. Int J Infect Dis 2020;98:225-6. DOI: https://doi.org/10.1016/j.ijid.2020.06.066
  35. Manolis AS, Manolis TA, Manolis AA, Papatheou D, Melita H. COVID-19 infection: Viral macro- and micro-vascular coagulopathy and thromboembolism/prophylactic and therapeutic management. J Cardiovasc Pharmacol Ther 2021;26:12-24. DOI: https://doi.org/10.1177/1074248420958973
  36. Jardin F, Delorme G, Hardy A, et al. Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 1990;72:966-70. DOI: https://doi.org/10.1097/00000542-199006000-00003
  37. Pfeifer M, Ewig S, Voshaar T, et al. Position Paper for the state-of-the-art application of respiratory support in patients with COVID-19. Respiration 2020;99:521-42. DOI: https://doi.org/10.1159/000509104
  38. Crimi C, Pierucci P, Renda T, et al. High flow nasal cannula and COVID-19: A clinical review. Respiratory Care 2021;respcare.09056. DOI: https://doi.org/10.4187/respcare.09056

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