https://doi.org/10.4081/monaldi.2022.2142

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

Vol. 92 No. 4 (2022)
Submitted: November 4, 2021
Accepted: December 16, 2021
Published: January 19, 2022
COVID-19, ARDS, Cardiorespiratory sequelae, Pulmonary emboli, non-invasive ventilation, CPAP, long COVID-19
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Supplementary: 156
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Authors

Lucrezia De Michele
Cardio Thoracic and Vascular Department, University Hospital Policlinic of Bari, Italy.
Paola Pierucci
paola.pierucci@policlinico.ba.it
Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
Guido Giovannetti
Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro' Medical School, Bari , Italy.
Michele De Ceglie
DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari , Italy.
Michela Dimitri
Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
Alessandra Mirabile
DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari , Italy.
Vitaliano Quaranta
Respiratory Unit, Di Venere Hospital, Bari, Italy.
Arnaldo Scardapane
DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari, Italy.
Carlo D'Agostino
DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari, Italy.
Giovanna Elisiana Carpagnano
Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy.

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. 

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
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
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
Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020;323:2329-30. DOI: https://doi.org/10.1001/jama.2020.6825
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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

How to Cite

De Michele, Lucrezia, Paola Pierucci, Guido Giovannetti, Michele De Ceglie, Michela Dimitri, Alessandra Mirabile, Vitaliano Quaranta, Arnaldo Scardapane, Carlo D’Agostino, and Giovanna Elisiana Carpagnano. 2022. “Post Severe COVID-19 Infection Lung Damages Study. The Experience of Early Three Months Multidisciplinary Follow-up”. Monaldi Archives for Chest Disease 92 (4). https://doi.org/10.4081/monaldi.2022.2142.
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