Failing categorization of severe COVID-19 ARDS into ventilatory subphenotypes studied via the clinical-histopathologic relationship.
- Resource Type
- Academic Journal
- Authors
- Colombo R; Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy. Electronic address: riccardo.colombo@unimi.it.; Wu MA; Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy.; Ottolina D; Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy.; Fossali T; Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy.; Montomoli J; Division of Anesthesiology and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini.; Lopez G; Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy; Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy.; Catena E; Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Milan, Italy.; Nebuloni M; Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Biological Sciences, University of Milan, Italy.
- Source
- Publisher: Elsevier Country of Publication: England NLM ID: 8908438 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-3064 (Electronic) Linking ISSN: 09546111 NLM ISO Abbreviation: Respir Med Subsets: MEDLINE
- Subject
- Language
- English
Background: Categorization of severe COVID-19 related acute respiratory distress syndrome (CARDS) into subphenotypes does not consider the trajectories of respiratory mechanoelastic features and histopathologic patterns. This study aimed to assess the correlation between mechanoelastic ventilatory features and lung histopathologic findings in critically ill patients who died because of CARDS.
Methods: Mechanically ventilated patients with severe CARDS who had daily ventilatory data were considered. The histopathologic assessment was performed through full autopsy of deceased patients. Patients were categorized into two groups according to the median worst respiratory system compliance during ICU stay (Crs ICU ).
Results: Eighty-seven patients admitted to ICU had daily ventilatory data. Fifty-one (58.6%) died in ICU, 41 (80.4%) underwent full autopsy and were considered for the clinical-histopathological correlation analysis. Respiratory system compliance at ICU admission and its trajectory were not different in survivors and non-survivors. Median Crs ICU in the deceased patients was 22.9 ml/cmH 2 O. An inverse correlation was found between the Crs ICU and late-proliferative diffuse alveolar damage (DAD) (r = -0.381, p = 0.026). Late proliferative DAD was more extensive (p = 0.042), and the probability of stay in ICU was higher (p = 0.004) in the "low" compared to the "high" Crs ICU group. Cluster analysis further endorsed these findings.
Conclusions: In critically ill mechanically ventilated patients, worsening of the respiratory system compliance correlated pathologically with the transition from early damage to late fibroproliferative patterns in non-survivors of CARDS. Categorization of CARDS into ventilatory subphenotypes by mechanoelastic properties at ICU admission does not account for the complexity of the histopathologic features.
Competing Interests: Declaration of competing interest The authors have no conflict of interests to declare.
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