Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up
Accepted: December 16, 2021
Supplementary: 205
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The correct type and time of follow-up for patients affected by COVID-19 ARDS is still unclear. The aim of this study was to evaluate the survivors of COVID-19 ARDS requiring non-invasive respiratory support (NRS) admitted to a Respiratory Intensive care unit (RICU) from March 8th till May 31st 2020 looking at all sequelae via a comprehensive follow up. All patients underwent a multi-disciplinary instrumental and clinical assessment within three months form admission to evaluate all infection related sequelae. Thirty-eight patients were enrolled lung-ultrasound (LUS) showed an outstanding discrimination ability (ROC AUC: 0.95) and a substantial agreement rate (Cohen’s K: 0.74) compared to chest CT-scan detecting improvement of lung consolidations. Youden’s test showed a cut-off pressure of 11 cm H2O ExpiratoryPAP-continuous-PAP-max (EPAP-CPAP) applied at the airways during hospitalization to be significantly correlated (p-value=0.026) to the increased pulmonary artery common trunk diameter. A total of 8/38 patients (21.8%), 2 of whom during follow-up, were diagnosed with pulmonary emboli (PE) and started anticoagulant treatment. Patients with PE had a statistically significant shorter length of time of hospitalization, time to negative swab, CPAP/NIV duration, P/F ratio and D-dimers at follow-up compared to non-PE. A comprehensive approach to patients with ARDS COVID-19 requiring NRS is necessary. This study highlighted cardiopulmonary impairment related to the ARDS and to the high-EPAP-CPAP-max greater than 11 mmHg provided during admission, the usefulness of LUS in monitoring post-infection recovery and the correct identification and treatment of patients with PE during follow up.
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