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Essential Multiorgan Pathophysiology of COVID-19

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COVID-19 Critical and Intensive Care Medicine Essentials
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Abstract

Typical manifestations of coronavirus disease-2019 (COVID-19) include mild-to-moderate “flu-like” symptoms, although more severe manifestations have been reported. The pathophysiology of COVID-19 is complex, and its clinical spectrum might not be limited to local pneumonia, but rather may represent a multisystem illness with potential for severe acute respiratory distress syndrome (ARDS) and multiorgan impairment. In this context, the aim of the present handbook is to provide an overview of possible multisystemic manifestations and therapeutic strategies, in order to guide the clinician to deal with COVID-19 critical illness and to prevent potential systemic consequences.

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References

  1. Wouters OJ, Shadlen KC, Salcher-Konrad M, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. 2021;397(10278):1023–34. https://doi.org/10.1016/S0140-6736(21)00306-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–15. https://doi.org/10.1038/s41591-021-01283-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Robba C, Battaglini D, Pelosi P, Rocco PRM. Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2. Expert Rev Respir Med. 2020;14(9):865–8. https://doi.org/10.1080/17476348.2020.1778470.

    Article  CAS  PubMed  Google Scholar 

  4. Lopes-Pacheco M, Silva PL, Cruz FF, et al. Pathogenesis of multiple organ injury in COVID-19 and potential therapeutic strategies. Front Physiol. 2021;12:593223. https://doi.org/10.3389/fphys.2021.593223.

    Article  PubMed  PubMed Central  Google Scholar 

  5. V’kovski P, Kratzel A, Steiner S, Stalder H, Thiel V. Coronavirus biology and replication: implications for SARS-CoV-2. Nat Rev Microbiol. 2021;19(3):155–70. https://doi.org/10.1038/s41579-020-00468-6.

    Article  CAS  PubMed  Google Scholar 

  6. Shang J, Wan Y, Luo C, et al. Cell entry mechanisms of SARS-CoV-2. Proc Natl Acad Sci. 2020;117(21):11727–34. https://doi.org/10.1073/pnas.2003138117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rouse BT, Sehrawat S. Immunity and immunopathology to viruses: what decides the outcome? Nat Rev Immunol. 2010;10(7):514–26. https://doi.org/10.1038/nri2802.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–7. https://doi.org/10.1002/path.1570.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Orlandi D, Battaglini D, Robba C, et al. COVID-19 phenotypes, lung ultrasound, chest computed tomography, and clinical features in critically ill mechanically ventilated patients. Ultrasound Med Biol. 2021;47(12):3323–32. https://doi.org/10.1016/j.ultrasmedbio.2021.07.014.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pelosi P, Ball L, Barbas CSV, et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care. 2021;25(1):250. https://doi.org/10.1186/s13054-021-03686-3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102. https://doi.org/10.1007/s00134-020-06033-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Robba C, Battaglini D, Ball L, et al. Distinct phenotypes require distinct respiratory management strategies in severe COVID-19. Respir Physiol Neurobiol. 2020;279:103455.

    Article  CAS  Google Scholar 

  13. Tonelli R, Marchioni A, Tabbì L, et al. Spontaneous breathing and evolving phenotypes of lung damage in patients with COVID-19: review of current evidence and forecast of a new scenario. J Clin Med. 2021;10(5):975. https://doi.org/10.3390/jcm10050975.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ball L, Robba C, Herrmann J, et al. Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study. Crit Care. 2021;25(1):214. https://doi.org/10.1186/s13054-021-03610-9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Battaglini D, Robba C, Ball L, et al. Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. Br J Anaesth. 2021;127(3):353–64. https://doi.org/10.1016/j.bja.2021.05.024.

    Article  CAS  PubMed  Google Scholar 

  16. Battaglini D, Brunetti I, Anania P, et al. Neurological manifestations of severe SARS-CoV-2 infection: potential mechanisms and implications of individualized mechanical ventilation settings. Front Neurol. 2020;11:845. https://doi.org/10.3389/fneur.2020.00845.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ball L, Robba C, Maiello L, et al. Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia. Crit Care. 2021;25(1):81. https://doi.org/10.1186/s13054-021-03477-w.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Robba C, Ball L, Battaglini D, et al. Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study. Crit Care. 2021;25(1):111. https://doi.org/10.1186/s13054-021-03537-1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. https://doi.org/10.1001/jama.2020.1585.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802. https://doi.org/10.1001/jamacardio.2020.0950.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li J-W, Han T-W, Woodward M, et al. The impact of 2019 novel coronavirus on heart injury: a systematic review and meta-analysis. Prog Cardiovasc Dis. 2020;63(4):518–24. https://doi.org/10.1016/j.pcad.2020.04.008.

    Article  PubMed  PubMed Central  Google Scholar 

  22. De Marzo V, Di Biagio A, Della Bona R, et al. Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19. J Geriatr Cardiol. 2021;18(5):338–45. https://doi.org/10.11909/j.issn.1671-5411.2021.05.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Robba C, Battaglini D, Ball L, et al. Coagulative disorders in critically ill COVID-19 patients with acute distress respiratory syndrome: a critical review. J Clin Med. 2021;10(1):140. https://doi.org/10.3390/jcm10010140.

    Article  CAS  PubMed Central  Google Scholar 

  24. Wang M, Xiong H, Chen H, Li Q, Ruan XZ. Renal injury by SARS-CoV-2 infection: a systematic review. Kidney Dis. 2020;16:1–11. https://doi.org/10.1159/000512683.

    Article  CAS  Google Scholar 

  25. Battaglini D, Robba C, Fedele A, et al. The role of dysbiosis in critically ill patients with COVID-19 and acute respiratory distress syndrome. Front Med. 2021;8:671714. https://doi.org/10.3389/fmed.2021.671714.

    Article  Google Scholar 

  26. Cho S-M, Premraj L, Fanning J, et al. Ischemic and hemorrhagic stroke among critically ill patients with Coronavirus disease 2019 Critical Care Consortium Study. Crit Care Med. 2021;49(12):e1223. https://doi.org/10.1097/CCM.0000000000005209.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Huth SF, Cho S-M, Robba C, et al. Neurological manifestations of Coronavirus disease 2019: a comprehensive review and meta-analysis of the first 6 months of pandemic reporting. Front Neurol. 2021;12:664599. https://doi.org/10.3389/fneur.2021.664599.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Shao S-C, Lai C-C, Chen Y-H, Chen Y-C, Hung M-J, Liao S-C. Prevalence, incidence and mortality of delirium in patients with COVID-19: a systematic review and meta-analysis. Age Ageing. 2021;50(5):1445–53. https://doi.org/10.1093/ageing/afab103.

    Article  PubMed  Google Scholar 

  29. Battaglini D, Santori G, Chandraptham K, et al. Neurological complications and noninvasive multimodal neuromonitoring in critically ill mechanically ventilated COVID-19 patients. Front Neurol. 2020;11:602114. https://doi.org/10.3389/fneur.2020.602114.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: current knowledge and future perspectives. Dermatology. 2021;237(1):1–12. https://doi.org/10.1159/000512932.

    Article  CAS  PubMed  Google Scholar 

  31. Gavriatopoulou M, Korompoki E, Fotiou D, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med. 2020;20(4):493–506. https://doi.org/10.1007/s10238-020-00648-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Battaglini, D., Pelosi, P. (2022). Essential Multiorgan Pathophysiology of COVID-19. In: Battaglini, D., Pelosi, P. (eds) COVID-19 Critical and Intensive Care Medicine Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-94992-1_1

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  • DOI: https://doi.org/10.1007/978-3-030-94992-1_1

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