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Article ; Online: COVID-19 pneumonia: pathophysiology and management.

Gattinoni, Luciano / Gattarello, Simone / Steinberg, Irene / Busana, Mattia / Palermo, Paola / Lazzari, Stefano / Romitti, Federica / Quintel, Michael / Meissner, Konrad / Marini, John J / Chiumello, Davide / Camporota, Luigi

European respiratory review : an official journal of the European Respiratory Society

2021 Volume 30, Issue 162

Abstract: Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus ... on the development of its pathophysiologic characteristics over time, and how these time-related changes determine ... In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift ...

Abstract	Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. The underlying mechanism is primarily altered lung perfusion. The anatomical prerequisites for PEEP (positive end-expiratory pressure) to work (lung oedema, atelectasis, and therefore recruitability) are lacking. In the high-dependency unit: the disease starts to worsen either because of its natural evolution or additional patient self-inflicted lung injury (P-SILI). Oedema and atelectasis may develop, increasing recruitability. Noninvasive supports are indicated if they result in a reversal of hypoxaemia and a decreased inspiratory effort. Otherwise, mechanical ventilation should be considered to avert P-SILI. In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift from oedema or atelectasis to less reversible structural lung alterations to lung fibrosis. These later characteristics are associated with notable impairment of respiratory mechanics, increased arterial carbon dioxide tension (
MeSH term(s)	COVID-19/physiopathology ; COVID-19/therapy ; Humans ; Lung/physiopathology ; Positive-Pressure Respiration/methods ; Pulmonary Atelectasis/prevention & control ; Respiration, Artificial/methods ; Respiratory Mechanics ; SARS-CoV-2
Language	English
Publishing date	2021-10-20
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1077620-5
ISSN	1600-0617 ; 0905-9180
ISSN (online)	1600-0617
ISSN	0905-9180
DOI	10.1183/16000617.0138-2021
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Article ; Online: Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management.

Cajanding, Ruff Joseph Macale

AACN advanced critical care

2022 Volume 33, Issue 2, Page(s) 143–153

Abstract: ... in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer ... Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs ... to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes ...

Abstract	Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.
MeSH term(s)	COVID-19 ; Dyspnea/complications ; Humans ; Hypoxia/diagnosis ; Hypoxia/therapy ; Oxygen ; SARS-CoV-2
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-02-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239949-5
ISSN	1559-7776 ; 1559-7768
ISSN (online)	1559-7776
ISSN	1559-7768
DOI	10.4037/aacnacc2022448
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Article: Role of chest radiography in the management of COVID-19 pneumonia: An overview and correlation with pathophysiologic changes.

Kohli, Anirudh / Hande, Pradipta C / Chugh, Shivam

The Indian journal of radiology & imaging

2021 Volume 31, Issue Suppl 1, Page(s) S70–S79

Abstract: ... for suspected and confirmed COVID-19 patients on initial presentation to the emergency medical services (EMS ... with suspected or confirmed Covid-19 presenting to the EMS as it helps to monitor the progress and regression ... in evaluating symptomatic patients with suspected or confirmed Covid-19 disease. Serial changes can help in monitoring ...

Abstract	Background: Chest radiography (CXR) is a widely available baseline radiological modality in evaluating symptomatic patients with suspected or confirmed Covid-19 disease. Serial changes can help in monitoring the patients in conjunction with the clinical status of these patients in a hospital setting. Purpose: The purpose of this study was to analyse the patterns of radiological findings on chest radiograph (CXR) for suspected and confirmed COVID-19 patients on initial presentation to the emergency medical services (EMS) on admission and to assess the progression and resolution. Materials and methods: In this study, patients who presented to EMS of a multispeciality hospital as suspected or confirmed Covid-19 on consecutive reverse transcriptase polymerase chain reaction (RT-PCR). CXR was examined for findings of haziness, patterns and distribution of opacities. Progression and regression of findings in serial CXR were studied and evaluated with the clinical and laboratory parameters. High resolution CT (HRCT) chest was performed initially for some patients. Results: 756 RT-PCR confirmed COVID-19 patients were included in our study who had initial CXR. 510 (67.46%) of our patients with positive initial RT-PCR showed abnormal baseline CXR. The abnormal findings were described as haziness akin to ground glass opacities (GGO) on CT, peripheral opacities, patchy parenchymal opacities and consolidation. Peripheral opacities and lower zone distribution were the commonest pattern of CXR abnormalities with bilateral involvement. The severity of findings on serial CXR and radiographic regression was studied along with follow-up to assess response to treatment. Forty-six patients showed features of acute lung injury (ALI). Complications and new CXR findings were reported for patients who were given ventilator support. Conclusion: CXR is a valuable baseline radiological investigation on hospital admission in symptomatic patients with suspected or confirmed Covid-19 presenting to the EMS as it helps to monitor the progress and regression of the disease in conjunction with clinical findings.
Language	English
Publishing date	2021-01-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605869-3
ISSN	0971-3026 ; 0970-2016
ISSN	0971-3026 ; 0970-2016
DOI	10.4103/ijri.IJRI_967_20
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Article: Role of chest radiography in the management of COVID-19 pneumonia: An overview and correlation with pathophysiologic changes

Kohli, Anirudh / Hande, Pradipta C / Chugh, Shivam

Indian Journal of Radiology and Imaging

2021 Volume 31, Issue S 01, Page(s) S70–S79

Abstract	Background: Chest radiography (CXR) is a widely available baseline radiological modality in evaluating symptomatic patients with suspected or confirmed Covid-19 disease. Serial changes can help in monitoring the patients in conjunction with the clinical status of these patients in a hospital setting. Purpose: The purpose of this study was to analyse the patterns of radiological findings on chest radiograph (CXR) for suspected and confirmed COVID-19 patients on initial presentation to the emergency medical services (EMS) on admission and to assess the progression and resolution. Materials and Methods: In this study, patients who presented to EMS of a multispeciality hospital as suspected or confirmed Covid-19 on consecutive reverse transcriptase polymerase chain reaction (RT-PCR). CXR was examined for findings of haziness, patterns and distribution of opacities. Progression and regression of findings in serial CXR were studied and evaluated with the clinical and laboratory parameters. High resolution CT (HRCT) chest was performed initially for some patients. Results: 756 RT-PCR confirmed COVID-19 patients were included in our study who had initial CXR. 510 (67.46%) of our patients with positive initial RT-PCR showed abnormal baseline CXR. The abnormal findings were described as haziness akin to ground glass opacities (GGO) on CT, peripheral opacities, patchy parenchymal opacities and consolidation. Peripheral opacities and lower zone distribution were the commonest pattern of CXR abnormalities with bilateral involvement. The severity of findings on serial CXR and radiographic regression was studied along with follow-up to assess response to treatment. Forty-six patients showed features of acute lung injury (ALI). Complications and new CXR findings were reported for patients who were given ventilator support. Conclusion: CXR is a valuable baseline radiological investigation on hospital admission in symptomatic patients with suspected or confirmed Covid-19 presenting to the EMS as it helps to monitor the progress and regression of the disease in conjunction with clinical findings.
Keywords	Acute lung injury ; Covid-19 pneumonia ; ventilator-associated pneumonia
Language	English
Publishing date	2021-01-01
Publisher	Thieme Medical and Scientific Publishers Private Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605869-3
ISSN	1998-3808 ; 0971-3026 ; 0970-2016
ISSN (online)	1998-3808
ISSN	0971-3026 ; 0970-2016
DOI	10.4103/ijri.IJRI_967_20
Database	Thieme publisher's database

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Article: COVID-19-Pneumonie.

Pfeifer, M / Hamer, O W

Der Gastroenterologe : Zeitschrift fur Gastroenterologie und Hepatologie

2020 Volume 15, Issue 6, Page(s) 457–470

Abstract: ... unique pathophysiology of COVID-19 pneumonia. Radiological features are addressed. Therapy is mainly ... for the diagnosis of COVID-19. Radiology and especially high-resolution computed tomography (HRCT) are important ... The prognosis of patients with the coronavirus disease 2019 (COVID-19) is determined ...

Title translation	COVID-19 pneumonia.
Abstract	The prognosis of patients with the coronavirus disease 2019 (COVID-19) is determined by the severity of lower respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of patients demonstrate mild symptoms only. However, development of pneumonia is associated with the risk of severe respiratory insufficiency. Reverse transcriptase polymerase chain reaction (RT-PCR) of specimens from the upper and/or lower respiratory tract is the gold standard for the diagnosis of COVID-19. Radiology and especially high-resolution computed tomography (HRCT) are important for diagnosis and follow-up. This narrative review provides an overview of clinical signs and the complex and unique pathophysiology of COVID-19 pneumonia. Radiological features are addressed. Therapy is mainly supportive with the most important task being management of respiratory insufficiency. Recently, promising data were presented regarding effectiveness of antiviral and anti-inflammatory drugs.
Keywords	covid19
Language	German
Publishing date	2020-11-11
Publishing country	Germany
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240307-3
ISSN	1861-969X ; 1861-9681
ISSN (online)	1861-969X
ISSN	1861-9681
DOI	10.1007/s11377-020-00488-x
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Article ; Online: Pathophysiology of COVID-19 pneumonia and respiratory treatment.

Velati, Mara / D'Albo, Rosanna / Brusatori, Serena / Lombardo, Fabio / Maj, Roberta / Zinnato, Carmelo / Gattarello, Simone / Busana, Mattia / Romitti, Federica / Moerer, Onnen / Meissner, Konrad / Gattinoni, Luciano

Minerva anestesiologica

2023 Volume 89, Issue 6, Page(s) 577–585

Abstract: ... we performed research on PubMed screening all publications on COVID-19 disease and respiratory failure and ... mechanics and PaCO2 tension. The management of symptomatic patients, progressing ... COVID-19 pandemic has seen an unprecedented number of patients presenting with acute respiratory ...

Abstract	COVID-19 pandemic has seen an unprecedented number of patients presenting with acute respiratory distress syndrome to the intensive care units all over the world. Between August and November 2022, we performed research on PubMed screening all publications on COVID-19 disease and respiratory failure and its treatment. In this review we focused on COVID-19 most common manifestations concerning lung function. The respiratory infection develops in three broad phases: early, intermediate, and late. The mainstay of the disease is the frequent presence of severe hypoxemia associated - at least at the beginning - to a near normal lung mechanics and PaCO<inf>2</inf> tension. The management of symptomatic patients, progressing through these temporal phases, is not possible without understanding the pathophysiology underlying the respiratory manifestation.
MeSH term(s)	Humans ; COVID-19 ; SARS-CoV-2 ; Pandemics ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Respiration Disorders
Language	English
Publishing date	2023-03-31
Publishing country	Italy
Document type	Review ; Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.23.17188-4
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Article ; Online: COVID-19-Pneumonie.

Pfeifer, M / Hamer, O W

Der Internist

2020 Volume 61, Issue 8, Page(s) 793–803

Abstract: ... respiratory distress syndrome and the major effects these have on the treatment of COVID-19 are elucidated ... findings, imaging of COVID-19 pneumonia is described in greater details (typical findings ... differential diagnoses, grading of the likelihood of COVID-19 pneumonia). This is followed by a description of symptoms ...

Title translation	COVID-19 pneumonia.
Abstract	Coronavirus disease 2019 (COVID-19) continues to pose a major global threat. Although a wide range of organ manifestations have now been described, the respiratory system remains in the forefront in terms of the course of infection. Severe pneumonia can develop and is generally prognostically relevant. The following article discusses currently known features of these pulmonary manifestations from a pathophysiological, symptomatological, and radiological perspective. With regard to pathophysiology, the complex nature of the acute pulmonary disease involving severe injury to the alveolar epithelium and pulmonary vascular endothelium resulting in severe respiratory failure in a proportion of patients is discussed. The differences from "classic" acute respiratory distress syndrome and the major effects these have on the treatment of COVID-19 are elucidated. Following a brief description of PCR-based pathogen identification and information on typical laboratory findings, imaging of COVID-19 pneumonia is described in greater details (typical findings, differential diagnoses, grading of the likelihood of COVID-19 pneumonia). This is followed by a description of symptoms, which develop in three phases. With regard to treatment, supportive and intensive care approaches are discussed, including O
MeSH term(s)	Airway Management ; Antiviral Agents/therapeutic use ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnostic imaging ; Coronavirus Infections/drug therapy ; Coronavirus Infections/physiopathology ; Coronavirus Infections/therapy ; Humans ; Immunomodulation ; Pandemics ; Pneumonia, Viral/diagnostic imaging ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/therapy ; SARS-CoV-2 ; COVID-19 Drug Treatment
Chemical Substances	Antiviral Agents
Keywords	covid19
Language	German
Publishing date	2020-07-30
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2913-0
ISSN	1432-1289 ; 0020-9554
ISSN (online)	1432-1289
ISSN	0020-9554
DOI	10.1007/s00108-020-00854-5
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Article ; Online: Severe pediatric COVID-19: a review from the clinical and immunopathophysiological perspectives.

Sun, Yi-Kan / Wang, Can / Lin, Pei-Quan / Hu, Lei / Ye, Jing / Gao, Zhi-Gang / Lin, Ru / Li, Hao-Min / Shu, Qiang / Huang, Li-Su / Tan, Lin-Hua

World journal of pediatrics : WJP

2024 Volume 20, Issue 4, Page(s) 307–324

Abstract: ... roles in severe COVID-19 pathophysiology but remain incompletely understood.: Data sources ... the PubMed, Embase, and Wanfang databases. Searched keywords included "COVID-19 in children", "severe ... pediatric COVID-19", and "critical illness in children with COVID-19".: Results: Risks of developing ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) tends to have mild presentations in children. However, severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times, meriting further attention from clinicians. Meanwhile, the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood. Data sources: A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included "COVID-19 in children", "severe pediatric COVID-19", and "critical illness in children with COVID-19". Results: Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines. Conclusions: Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
MeSH term(s)	Humans ; COVID-19/immunology ; COVID-19/complications ; Child ; Systemic Inflammatory Response Syndrome/immunology ; Systemic Inflammatory Response Syndrome/physiopathology ; Severity of Illness Index
Language	English
Publishing date	2024-02-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2236681-7
ISSN	1867-0687 ; 1708-8569
ISSN (online)	1867-0687
ISSN	1708-8569
DOI	10.1007/s12519-023-00790-y
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Article ; Online: Gestational diabetes mellitus in the era of COVID-19: Challenges and opportunities.

Xing, Yuhan / Wang, Hong / Chao, Cong / Ding, Xueteng / Li, Guoju

Diabetes & metabolic syndrome

2024 Volume 18, Issue 3, Page(s) 102991

Abstract: ... pregnancy could also increase the risk of severe COVID-19 in mothers with GDM. Personalized management and ... This review aims to examine the interaction between GDM and COVID-19 and to elucidate the pathophysiological ... distinct clinical manifestations, GDM and COVID-19 share common pathophysiological characteristics ...

Abstract	Background and aims: The impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women, especially those with gestational diabetes mellitus (GDM), has yet to be fully understood. This review aims to examine the interaction between GDM and COVID-19 and to elucidate the pathophysiological mechanisms underlying the comorbidity of these two conditions. Methods: We performed a systematic literature search using the databases of PubMed, Embase, and Web of Science with appropriate keywords and MeSH terms. Our analysis included studies published up to January 26, 2023. Results: Despite distinct clinical manifestations, GDM and COVID-19 share common pathophysiological characteristics, which involve complex interactions across multiple organs and systems. On the one hand, infection with severe acute respiratory syndrome coronavirus 2 may target the pancreas and placenta, resulting in β-cell dysfunction and insulin resistance in pregnant women. On the other hand, the hormonal and inflammatory changes that occur during pregnancy could also increase the risk of severe COVID-19 in mothers with GDM. Personalized management and close monitoring are crucial for treating pregnant women with both GDM and COVID-19. Conclusions: A comprehensive understanding of the interactive mechanisms of GDM and COVID-19 would facilitate the initiation of more targeted preventive and therapeutic strategies. There is an urgent need to develop novel biomarkers and functional indicators for early identification and intervention of these conditions.
MeSH term(s)	Humans ; COVID-19/epidemiology ; COVID-19/complications ; Pregnancy ; Diabetes, Gestational/epidemiology ; Female ; SARS-CoV-2 ; Pregnancy Complications, Infectious/virology ; Pregnancy Complications, Infectious/epidemiology ; Pandemics ; Coronavirus Infections/epidemiology ; Coronavirus Infections/complications ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/complications ; Pneumonia, Viral/virology ; Betacoronavirus
Language	English
Publishing date	2024-03-22
Publishing country	Netherlands
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2273766-2
ISSN	1878-0334 ; 1871-4021
ISSN (online)	1878-0334
ISSN	1871-4021
DOI	10.1016/j.dsx.2024.102991
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Article: COVID-19: Diabetes Perspective-Pathophysiology and Management.

Dallavalasa, Siva / Tulimilli, SubbaRao V / Prakash, Janhavi / Ramachandra, Ramya / Madhunapantula, SubbaRao V / Veeranna, Ravindra P

Pathogens (Basel, Switzerland)

2023 Volume 12, Issue 2

Abstract: ... mechanisms linking COVID-19 and diabetes, and presents clinical management recommendations for better ... to emerge. COVID-19 pneumonia is a newly identified illness spreading rapidly throughout the world and ... of COVID-19 infection in people with diabetes have been proposed and explained in detail recently ...

Abstract	Recent evidence relating to the impact of COVID-19 on people with diabetes is limited but continues to emerge. COVID-19 pneumonia is a newly identified illness spreading rapidly throughout the world and causes many disabilities and fatal deaths. Over the ensuing 2 years, the indirect effects of the pandemic on healthcare delivery have become prominent, along with the lingering effects of the virus on those directly infected. Diabetes is a commonly identified risk factor that contributes not only to the severity and mortality of COVID-19 patients, but also to the associated complications, including acute respiratory distress syndrome (ARDS) and multi-organ failure. Diabetic patients are highly affected due to increased viral entry into the cells and decreased immunity. Several hypotheses to explain the increased incidence and severity of COVID-19 infection in people with diabetes have been proposed and explained in detail recently. On the other hand, 20-50% of COVID-19 patients reported new-onset hyperglycemia without diabetes and new-onset diabetes, suggesting the two-way interactions between COVID-19 and diabetes. A systematic review is required to confirm diabetes as a complication in those patients diagnosed with COVID-19. Diabetes and diabetes-related complications in COVID-19 patients are primarily due to the acute illness caused during the SARS-CoV-2 infection followed by the release of glucocorticoids, catecholamines, and pro-inflammatory cytokines, which have been shown to drive hyperglycemia positively. This review provides brief insights into the potential mechanisms linking COVID-19 and diabetes, and presents clinical management recommendations for better handling of the disease.
Language	English
Publishing date	2023-01-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens12020184
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