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Introduction: NIRS reduces intubation rate in COVID-19 pneumonia. Outcome is related to age, comorbidities, and baseline illness severity. Thoracic CT has prognostic value in COVID-19 pneumonia. Forced Oscillatory Technique (FOT) allows non-invasive assessment of respiratory reactance (Xrs) that is related to lung compliance. A pilot study showed FOT feasibility in patients with COVID-19 pneumonia receiving NIRS (1). Aim(s): Measuring Xrs in COVID19 patients receiving NIRS and correlate with CT. Method(s): The local ERB approved the study. 32 consecutive patients with moderate-severe COVID-19 ARDS were enrolled. Patients underwent non-invasive ventilation (NIV) alternated to High Flow Nasal Cannula (HFNC). In the first 24 hours of hospitalization triplicate FOT measurements were performed (Resmon ProFULL) according to current guidelines during HFNC. Within 1 week 28 patients underwent computed tomographic pulmonary angiography (CTPA) and collapsed, infiltrated and normally inflated areas were quantified (3D Slicer software). Result(s): 12 patients had altered Xrs-z score. Collapsed areas correlated with Xrs z-score (rho=0.37;p=0.046) and almost with inspiratory Xrs (rho=-0.36;p=0.055). Inflated areas correlated with inspiratory Xrs (rho=0.42;p=0.024) while infiltrated areas didn't. In our cohort CTPA and FOT parameters didn't discriminate outcomes but inflated areas were inversely related to hospitalization (rho=-0.43;p=0.04). Conclusion(s): FOT showed abnormal Xrs in a subset of patients. Xrs z-score is a noninvasive index of collapsed areas in COVID-19 pneumonia and could be useful in patients assessment and follow up.
ABSTRACT
Patients affected by COVID-19 can benefit from rehabilitation intervention that must be cali-brated according to the severity of the disease: it can therefore vary from pronation and early mobilization maneuvers for patients admitted to intensive care, to re-training programs and exercise after remission;in case of difficulty in managing secretions, rehabilitation intervention can be combined with bronchial clearance interventions.
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Background: COVID-19 pandemic is a global emergency which may overlap on the clinical and radiological scenario of ILD in SSc. In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 superinfection from a progression of SSc-ILD. Objectives: The aim of our study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia. Methods: 22 international readers were included and divided in the radiologist group (RAD) and non-radiologist group (nRAD). The RAD group included nonchest RAD and chest-RAD. A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. Results: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes;fibrosis in the lower lobe GGO;reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT parameters most frequently associated with SSc-ILD. The CT parameters most frequently associated with COVID-19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. These two variables were combined in a predictive score which resulted positively associated with the COVID-19 diagnosis, with 96.1% sensitivity and 83.3% specificity: 3 different risk class for COVID-19 pneumonia may be identified: high risk for COVID-19 pneumonia (5-9 points);probable overlap COVID-19 pneumonia in SSc-ILD (4 points);low risk for COVID-19 pneumonia (0-3 points). Conclusion: The CT differential diagnosis between COVID-19 Pneumonia and SSc-ILD is possible and may be fostered in practice by the use of a radiological score. In the case where an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
ABSTRACT
Backgrounds: Available data indicate that a large minority of patients with COVID-19 develop ARDS, and pulmonary fibrosis is a recognized sequela of ARDS. However, the long-term pulmonary consequences of COVID-19 remain speculative. The aim of this study is to evaluate risk factors, prevalence and characteristics of POST-COVID-19 interstitial lung changes, with the unique opportunity to evaluate radiologic and pathologic correlations using HRCT and transbronchial lung cryobiopsy specimens.Methods: Here we present the preliminary data on HRCT features of POST-COVID-19 ILD. Data were collected at the time of the first interim analysis (28/11/2020) of the PCOILS trial: a prospective, multicenter national study involving 12 Italian centers (Fig 1). We collected data of consecutively hospitalized patients at baseline and then at 6 (+/-1) months after hospital discharge. HRCT changes at 6 months involving more than 5% of the total lung volume were considered significant. Patients with significant HRCT changes will undergo BAL and/or cryobiopsy and a subsequent follow-up with HRCT and lung function evaluation at 12(+/-1) and 18 (+/-1) months.Results: At the time of the present interim analysis, 524 patients from 9 centers were enrolled (enrollment is still ongoing and will end on January 31st, 2021). Median age was 67 years (range 18-87), 330 were males (62.9%). HRCT changes were detected in 333 participants (63.5%), and in 219 (41.7%) were considered significant. 118 cases (22.5%) showed fibrotic changes including the following HRCT patterns: 7 (1.3%) probable UIP, 45 (8.5%) NSIP (with or without OP), 38 (7.2%) indeterminate, 28 (5.3%) fibrotic consolidations. Among the remaining 101 (19.2%) non fibrotic cases the radiologists described: 11 (2%) NSIP-OP, 15 (2.8%) indeterminate, 67 (12.7%) pure ground glass, 8 (1.5%) consolidations all suspected for lung cancer. Conclusions: This preliminary analysis confirms that after COVID-19 infection a large minority of patients develops interstitial lung changes mostly with NSIP-OP, indeterminate features or ground glass. The hypothesis that post-COVID-19 interstitial changes and interstitial lung diseases may share common risk factors, pathogenetic mechanisms and disease behaviour warrants further evaluations. .
ABSTRACT
Pneumonia represents the main cause of hospitalization and mortality secondary to SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) infection. The etiological diagnosis of COVID-19 pneumonia requires confirmation of the presence of viral genetic material detected with RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) test, usually obtained using nasopharyngeal or oropharyngeal swab;how-ever, several evidences demonstrate that a significant proportion of swabs, in particular at the first determination, results negative even in the presence of COVID-19 pneumonia. These patients may be erroneously hospitalized in a non-COVID-19 area and therefore contribute to the nosocomial transmission of the virus. For this reason the Italian Thoracic Society (ITS) promoted the production of a document that recommends a pragmatic approach to the COVID-19 pneumonia diagnosis with negative RT-PCR using a decisional clinical-radiological algorithm as a proxy to the commonly adopted gold standard, represented by RT-PCR, aimed at isolating patient and promoting investigations for a correct clinical-therapeutic classification. Difficulties in the first COVID-19 epidemic phase allowed us to know better characteristics and virus dangerousness. What we have learned has to be usefully implemented in clinical practice in order to contain the infection in the second and third phases to prevent a possible second wave of the infection during the autumnal period.