ABSTRACT
Aim of the study: The impact of COVID-19 pandemic put the Italian health system to the test. A retrospective analysis of an Internal Medicine ward experience in north of Italy is described. Materials and Methods: Between september 2020 and june 2021, the Internal Medicine unit of the M. Bufalini Hospital of Cesena managed 954 COVID-19 patients;339 of the totals were hospitalized in sub-intensive area, treated with high flow nasal cannula (25,5%) and non-invasive ventilation support (28,8%). To allow the management of these patients, compared to pre-pandemic, 47 beds and 24 to ordinary and sub-intensive area respectively were added. Results: Patients had an average age of 66 years and 62% of the total was female;prevalent comorbidities were arterial hypertension (53%), smoking habit (28,7%), obesity (27.9%), uncomplicated (10%) and complicated diabetes (9%). Hospitalization lasted about 7 days in the ordinary ward and 13 in the sub-intensive area. The overall mortality rate was 11%. In the considered period, the mean percentage of deaths compared to hospitalizations in Italy was equal to 22.21%. Conclusions: Our organizational model included different areas of intensity care in the same ward, various specialist skills as the pre-existing ability to manage non-invasive ventilation and bedside ultrasound knowledge, as well as an unitary organization and additional nursing assistance well trained. This allowed management of the “complex” COVID patient and even the mortality rate may be the result of this model. These features mark what modern internal medicine should be like.
ABSTRACT
Introduction: Lung Ultrasound was proposed as a diagnostic and follow-up toll for acute Sars-CoV-2 pneumonia. Information about its role in post-discharge is fewer. Materials and Methods: 53 patients with severe Sars-CoV-2 pneumonia, admitted in the period of March-May 2021 and treated with non-invasive ventilation, underwent a monthly follow-up post-discharge, including collection of symptoms, vital signs and lung ultrasound (LUS) exam with 14-zone method (damage score of 0-3). We compared all results (significance threshold: 0.05). Results: 69.8% of patients were male, a median age of 62 years. 79.3% of patients still presented at least one symptom at the first month with a significant decrease at next months;the median of dyspnea score (mMRC) decreased from 0-3(1st month) to 0-2(2nd month). Median of peripheral oxygen saturation significantly increased. Regarding the LUS score, a significant decrease has been observed between hospitalization (average: 21) and next months, as also a progressive decrease in its variability. All lung segments improved, except the anterior apices and the posterior middles areas. Conclusions: In first 3 months after discharge, we observed a progressive and significant reduction of Sars-CoV-2 related symptoms and an improvement in vital parameters. The congruent improvement in LUS exam helped the physician to confirm the positive trend or to anticipate other exams. “Long Covid” is a worrisome post-infectious condition for which health publics systems are investing in follow- up pathways. Lung ultrasound can preserve an important monitoring role.
ABSTRACT
Spontaneous pneumomediastinum (SPM) is among the rare complications of Coronavirus Disease-19 (COVID-19) and usually involves patients with a severe form of disease who are undergoing treatment with invasive/non-invasive ventilation or high-flow oxygen therapy. A very low percentage of SPM cases are detected in non-ventilated COVID-patients, the underlying causes of which are still to be understood. We report here on the case of a 65-year-old patient with no clinical history of cardiovascular or pulmonary disease who developed SPM within a few days following hospital admission. SPM was detected on chest CT-angiography, and was unrelated to high-flow oxygen treatment.