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Monaldi Arch Chest Dis ; 90(4)2020 Sep 18.
Article in English | MEDLINE | ID: covidwho-1060341


The coronavirus disease 2019 (COVID-19) is a recent pandemic that affected more than 5 million people worldwide. Chest high resolution computed tomography (HRCT) is an essential tool in diagnosis and management of the disease. Pulmonary parenchymal opacity is a typical sign of the disease, but not the only one. Pneumothorax, pneumomediastinum, bronchiectasis and cysts are probably underrated complications of COVID-19 that can worsen prognosis, in terms of prolonged hospitalization and need of oxygen therapy. In our single center case series, we outline four different manifestations of pneumothorax, pneumomediastinum and cysts in hospitalized patients with COVID-19 pneumonia.

Bronchiectasis/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Cysts/diagnostic imaging , Lung/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pneumothorax/diagnostic imaging , Adult , Betacoronavirus , Bronchiectasis/etiology , COVID-19 , Coronavirus Infections/complications , Cysts/etiology , Humans , Italy , Lung Diseases/diagnostic imaging , Lung Diseases/etiology , Male , Mediastinal Emphysema/etiology , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed
Anaesthesiol Intensive Ther ; 52(5): 373-376, 2020.
Article in English | MEDLINE | ID: covidwho-948839


INTRODUCTION: A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients. MATERIAL AND METHODS: Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2. RESULTS: Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days. CONCLUSIONS: HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions.

Airway Extubation/methods , COVID-19/complications , Catheterization , Nasal Cavity , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Adult , Aged , Airway Extubation/adverse effects , COVID-19/therapy , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Noninvasive Ventilation , Pneumonia/etiology , Pneumonia/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Treatment Outcome , Ventilator Weaning