ABSTRACT
Background: Even if definitive evidence is still missing, prone position in non-intubated hypoxemic patients with Covid-19 is largely used. The aim of the present study was to investigate whether the amount and distribution of lung abnormalities evaluated by CT-scan can predict the improvement of oxygenation when Covid-19 patients undergoing non-invasive ventilation (NIV) are turned prone. Method(s): Retrospective monocentric study of severe Covid-19 patients who underwent NIV and prone position, evaluated with a basal chest CT-scan. Result(s): Forty-five severe Covid-19 patients were considered. On average 50% of the overall lung volume was involved by pneumonia at CT-scan, with ground glass, and consolidation accounting for 44, and 4%, respectively. The parenchymal abnormalities were predominantly posterior, as demonstrated by a posterior/anterior ratio of ground glass and consolidation of 1.5, and 4.4, respectively. PaO2/FiO2, whose basal value under NIV in supine position was 140 [IQR 108;169] improved on average by 67% (+98) during prone position. Once supine position was resumed, improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as "responders"). We did not find significant difference between responders and non-responders in terms of the amount and distribution of parenchymal abnormalities. No correlation emerged between the distribution of parenchymal abnormalies and changes in oxygenation in supine position before and after prone position (R2 = 0.009, p= 0.526). Conclusion(s): the amount and distribution of lung abnormalities evaluated by CT-scan do not predict the response to awake prone position in patients with severe Covid-19 pneumonia undergoing non-invasive ventilation.
ABSTRACT
Background: Failing autoregulation of pulmonary vessels and higher shunt have been described in Covid-19 related Acute respiratory failure (ARF). The aim was to investigate shunt fraction in patients with Covid-19-ARF compared to patients with other causes of ARF. Method(s): Observational study of hospitalized patients with Covid-19-ARF and other causes of ARF at Papa Giovanni XXIII Hospital, Bergamo, Italy between June 2020 and November 2021. Shunt fraction was measured by a non-invasive system during spontaneous breathing (BeaconCaresystem). Result(s): We enrolled 51 adult patients (8 female), mean age (+/-SD) 65+/-13 years and mean BMI 28,3+/-5,3 Kg/m2. Covid-19-ARF patients represented 71% (36/51). Community acquired pneumonia was the most common cause of other ARF (11/15). No differences in terms of age and BMI were described between the two groups. Pulmonary gas exchange impairment was similar, median PaO2/FIO2 ratio was 254 [IQR 162,297] in Covid-19-ARF and 269 [IQR 201,296] in other causes of ARF patients (p=0.41). Nevertheless, mean shunt fraction resulted significantly increased in Covid-19-ARF (18+/-6%) than other causes of ARF patients (12+/-9%;p=0.03) Fig. 1. Conclusion(s): Shunt fraction appears to be increased in Covid-19-ARF if compared to patients with other causes of ARF. However, this is the first study proposing this non-invasive method to measure shunt fraction in ARF and further investigations are needed to validate this technique.
ABSTRACT
Background: In patients with pneumonia or ARDS who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients. Method(s): Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave. Result(s): A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). Inhospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19;95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52;95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93;95% CI 1.45-16.75, pvalue=0.010), and presence of active cancer (HR 3.64;95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity. Conclusion(s): One-year post-discharge mortality depends on underlying patients' comorbidities rather than COVID19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.