https://doi.org/10.4081/monaldi.2024.2829
Diaphragmatic morphological post-mortem findings in critically ill COVID-19 patients: an observational study
Submitted: October 20, 2023
Accepted: March 18, 2024
Published: April 23, 2024
Accepted: March 18, 2024
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PDF_EARLY VIEW: 154
SUPPLEMENTARY MATERIAL: 13
SUPPLEMENTARY MATERIAL: 13
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers’ atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.
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Ethics Approval
The study was approved by the Institutional Review Board of the University of Udine (IRB ID 086/2021, November 22, 2021). Consent to participation was waived due to the retrospective design of the study.How to Cite
Vetrugno, Luigi, Cristian Deana, Savino Spadaro, Gianmaria Cammarota, Domenico Luca Grieco, Annarita Tullio, Tiziana Bove, et al. 2024. “Diaphragmatic Morphological <i>post-mortem< i> Findings in Critically Ill COVID-19 Patients: An Observational Study”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2024.2829.
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