Respiratory function tests in the COVID-19 pandemic era. An update

Summary In June 2020, indications were developed for the resumption of pulmonary function testing in the course of a SARS-CoV-2 pandemic, in support of national, regional and company direc-tives, as well as for pulmonologists dedicated to pulmonary function laboratories. The present document represents an update of the previous one in the light of new knowledge and the current SARS-CoV-2 epidemiological situation.

Physiotherapy rehabilitation in acute phase COVID-19 patients: case series

Introduction. In March 2020, San Donato Hospital in Arezzo was converted into a COVID hospital 2020 due to the pandemic spreading of SARS-CoV-2 disease. Physiotherapists took part into the treatment and management in the newly established health care setting. Material and methods. Given the novelty of COVID disease and its clinical representation, we suggest a case series describing the treatment choices adopted by physiotherapists in the new COVID intensive care unit. Patients enrolled for treatment were monitored from admission to dimission through outcome measures already validated for well-known respiratory diseases. Consequently, physiotherapy treatment was inspired to the early mobilization protocol used in intensive respiratory care unit. Results. Results show general improvements of outcome measures and patients general conditions. Discussion and conclusions. These interventions may bring benefit to this new type of patients, even if it would be useful to compare other rehabilitation protocols. It would also be advisable to evaluate the conditions of clinical and respiratory function over time. In the case of acute comorbidity, the rehabilitation intervention is subject to the treatment of the primary symptoms due to COVID-19.

A multidisciplinary multicenter study evaluating risk factors, prevalence and characteristics of post-COVID-19 interstitial lung syndrome pcoils

Backgrounds: Available data indicate that a large minority of patients with COVID-19 develop ARDS, and pulmonary fibrosis is a recognized sequela of ARDS. However, the long-term pulmonary consequences of COVID-19 remain speculative. The aim of this study is to evaluate risk factors, prevalence and characteristics of POST-COVID-19 interstitial lung changes, with the unique opportunity to evaluate radiologic and pathologic correlations using HRCT and transbronchial lung cryobiopsy specimens.Methods: Here we present the preliminary data on HRCT features of POST-COVID-19 ILD. Data were collected at the time of the first interim analysis (28/11/2020) of the PCOILS trial: a prospective, multicenter national study involving 12 Italian centers (Fig 1). We collected data of consecutively hospitalized patients at baseline and then at 6 (+/-1) months after hospital discharge. HRCT changes at 6 months involving more than 5% of the total lung volume were considered significant. Patients with significant HRCT changes will undergo BAL and/or cryobiopsy and a subsequent follow-up with HRCT and lung function evaluation at 12(+/-1) and 18 (+/-1) months.Results: At the time of the present interim analysis, 524 patients from 9 centers were enrolled (enrollment is still ongoing and will end on January 31st, 2021). Median age was 67 years (range 18-87), 330 were males (62.9%). HRCT changes were detected in 333 participants (63.5%), and in 219 (41.7%) were considered significant. 118 cases (22.5%) showed fibrotic changes including the following HRCT patterns: 7 (1.3%) probable UIP, 45 (8.5%) NSIP (with or without OP), 38 (7.2%) indeterminate, 28 (5.3%) fibrotic consolidations. Among the remaining 101 (19.2%) non fibrotic cases the radiologists described: 11 (2%) NSIP-OP, 15 (2.8%) indeterminate, 67 (12.7%) pure ground glass, 8 (1.5%) consolidations all suspected for lung cancer. Conclusions: This preliminary analysis confirms that after COVID-19 infection a large minority of patients develops interstitial lung changes mostly with NSIP-OP, indeterminate features or ground glass. The hypothesis that post-COVID-19 interstitial changes and interstitial lung diseases may share common risk factors, pathogenetic mechanisms and disease behaviour warrants further evaluations. .

Pragmatic approach to the diagnosis of covid-19 pneumonia SARS-CoV-2 (COVID-19). from the epidemic phase to the two and three one

Pneumonia represents the main cause of hospitalization and mortality secondary to SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) infection. The etiological diagnosis of COVID-19 pneumonia requires confirmation of the presence of viral genetic material detected with RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) test, usually obtained using nasopharyngeal or oropharyngeal swab;how-ever, several evidences demonstrate that a significant proportion of swabs, in particular at the first determination, results negative even in the presence of COVID-19 pneumonia. These patients may be erroneously hospitalized in a non-COVID-19 area and therefore contribute to the nosocomial transmission of the virus. For this reason the Italian Thoracic Society (ITS) promoted the production of a document that recommends a pragmatic approach to the COVID-19 pneumonia diagnosis with negative RT-PCR using a decisional clinical-radiological algorithm as a proxy to the commonly adopted gold standard, represented by RT-PCR, aimed at isolating patient and promoting investigations for a correct clinical-therapeutic classification. Difficulties in the first COVID-19 epidemic phase allowed us to know better characteristics and virus dangerousness. What we have learned has to be usefully implemented in clinical practice in order to contain the infection in the second and third phases to prevent a possible second wave of the infection during the autumnal period.

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm.

COVID-19 related Acute Respiratory Failure, may be successfully treated with Conventional Oxygen therapy, High Flow Nasal Cannula, Continuous Positive Airway Pressure or Bi-level Positive-Pressure ventilation. Despite the accumulated data in favor of the use of different Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, it is not fully understood when start, escalate and de-escalate the best respiratory supportive option for the different timing of the disease. Based on the current published experience with Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, we propose an algorithm in deciding when to start, when to stop and when to wean different NIRT. This strategy may help clinicians in better choosing NIRT during this second COVID-19 wave and beyond.