Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients.

PURPOSE: Severe cases of coronavirus disease 2019 develop ARDS requiring admission to the ICU. This study aimed to investigate the ultrasound characteristics of respiratory and peripheral muscles of patients affected by COVID19 who require mechanical ventilation. MATERIALS AND METHODS: This is a prospective observational study. We performed muscle ultrasound at the admission of ICU in 32 intubated patients with ARDS COVID19. The ultrasound was comprehensive of thickness and echogenicity of both parasternal intercostal and diaphragm muscles, and cross-sectional area and echogenicity of the rectus femoris. RESULTS: Patients who survived showed a significantly lower echogenicity score as compared with those who did not survive for both parasternal intercostal muscles. Similarly, the diaphragmatic echogenicity was significantly different between alive or dead patients. There was a significant correlation between right parasternal intercostal or diaphragm echogenicity and the cumulative fluid balance and urine protein output. Similar results were detected for rectus femoris echogenicity. CONCLUSIONS: The early changes detected by echogenicity ultrasound suggest a potential benefit of proactive early therapies designed to preserve respiratory and peripheral muscle architecture to reduce days on MV, although what constitutes a clinically significant change in muscle echogenicity remains unknown.

Brainstem damage in COVID-19

Background and aims: It has recently been proposed that SARS-CoV-2 might spread through the nervous system in a prion-like way, reaching respiratory centers in the brainstem. Here, we evaluated neuropathologically, neurophysiologically and clinically the brainstem involvement in COVID-19. Methods: Neuropathological data were acquired from patients died for COVID-19 and COVID-19 negative;neuronal damage and the number of corpora amylacea (CA)/mm2 were assessed. The expression of the nuclear proteinof SARS-Cov-2 was also evaluated. To clarify whether neuropathological findings had a functional correlate, we studied the blink reflex (BR) in 11 COVID-19 patients, admitted to our Intensive Care Unit (ICU), and compared data both with healthy subjects and non COVID- 19 ICU patients. An extensive neurological examination, comprising the corneal and glabellar reflexes, was also performed. Results: Autopsies showed a high percentage of neuronal damage and a higher number of CA in the medulla oblongata of COVID-19 patients;immunohistochemistry revealed the presence of SARS-Cov-2 virus in the brainstem. Neurophysiologically, the RII component of the BR was selectively impaired in COVID-19 and, clinically, the glabellar reflex reduced or absent. Conclusion: Our findings provide the first combined neuropathological, neurophysiological and clinical evidence of SARS-Cov-2-related brainstem involvement, especially at the medullary level, suggesting a neurogenic component of respiratory failure.