https://doi.org/10.4081/monaldi.2024.2829

Diaphragmatic morphological post-mortem findings in critically ill COVID-19 patients: an observational study

Early Access
Submitted: October 20, 2023
Accepted: March 18, 2024
Published: April 23, 2024
COVID-19, invasive mechanical ventilation, diaphragm dysfunction, myosin, ventilation-induce diaphragm injury
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SUPPLEMENTARY MATERIAL: 11
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Authors

Luigi Vetrugno
luigi.vetrugno@unich.it
https://orcid.org/0000-0003-3745-8368
Department of Medical, Oral and Biotechnological Sciences, Gabriele d’Annunzio University of Chieti Pescara, Chieti; Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti, Italy.
Cristian Deana
Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Italy.
Savino Spadaro
Department of Translational Medicine, University of Ferrara; Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, Ferrara, Italy.
Gianmaria Cammarota
Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara; Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy.
Domenico Luca Grieco
https://orcid.org/0000-0002-4557-6308
Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
Annarita Tullio
https://orcid.org/0000-0003-3332-7459
Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Italy.
Tiziana Bove
https://orcid.org/0000-0002-5489-2898
Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine; Department of Medicine, University of Udine, Italy.
Carla Di Loreto
Department of Medicine, University of Udine; Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Italy.
Salvatore Maurizio Maggiore
https://orcid.org/0000-0002-1828-9143
Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy.
Maria Orsaria
https://orcid.org/0000-0001-9978-8130
Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Italy.
DIASUS study group

Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers’ atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.

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Ethics approval

The study was approved by the Institutional Review Board of the University of Udine (IRB ID 086/2021, November 22, 2021). Consent to participation was waived due to the retrospective design of the study.

How to Cite

Vetrugno, Luigi, Cristian Deana, Savino Spadaro, Gianmaria Cammarota, Domenico Luca Grieco, Annarita Tullio, Tiziana Bove, Carla Di Loreto, Salvatore Maurizio Maggiore, Maria Orsaria, and DIASUS study group. 2024. “Diaphragmatic Morphological <i>post-mortem</i> Findings in Critically Ill COVID-19 Patients: An Observational Study”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2024.2829.
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