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1. One-year survival and Quality of Life of first wave COVID-19 invasively ventilated patients in Lombardy, Italy

Author

Lorini, L, Labanca, R, Bugada, D, Cazzaniga, S, D'Amico, F, Grazioli, L, Marmiere, M, Novelli, L, Pozzi, M, Rona, R, Giani, M, Bellin, V, Lucchini, A, Raimondi, F, Rocchi, M, Salvioni, M, Foti, G, Landoni, G, Andreossi, M, Annoni, A, Azzolini, M, Baiardo Redaelli, M, Belletti, A, Belmonte, G, Benigni, A, Benini, A, Bonfanti, P, Borghi, G, Butovska, L, Cadone Ughi, E, Calabria, M, Celona, S, Ciceri, F, Consalvo, L, Farina, A, Ferlicca, D, Finazzi, S, Fominskiy, E, Grieco, S, Guzzo, F, Landini, S, Lo-Catelli, S, Lorini, A, Lorini, G, Magri, F, Manildo, E, Nava, C, Ortalda, A, Palumbo, D, Real, G, Rezoagli, E, Ripa, C, Saracino, M, Sosio, S, Trocchia, R, Villa, M, Zangrillo, A, Lorini L. F., Labanca R., Bugada D., Cazzaniga S., D'Amico F., Grazioli L., Marmiere M., Novelli L., Pozzi M., Rona R., Giani M., Bellin V., Lucchini A., Raimondi F., Rocchi M., Salvioni M. T., Foti G., Landoni G., Andreossi M., Annoni A., Azzolini M. L., Baiardo Redaelli M., Belletti A., Belmonte G., Benigni A., Benini A., Bonfanti P., Borghi G., Butovska L., Cadone Ughi E., Calabria M., Celona S., Ciceri F., Consalvo L., Farina A., Ferlicca D., Finazzi S., Fominskiy E. V., Grieco S., Guzzo F., Landini S., Lo-Catelli S., Lorini A., Lorini G., Magri F., Manildo E., Nava C., Ortalda A., Palumbo D., Real G., Rezoagli E., Ripa C., Saracino M., Sosio S., Trocchia R., Villa M., Zangrillo A., Lorini, L, Labanca, R, Bugada, D, Cazzaniga, S, D'Amico, F, Grazioli, L, Marmiere, M, Novelli, L, Pozzi, M, Rona, R, Giani, M, Bellin, V, Lucchini, A, Raimondi, F, Rocchi, M, Salvioni, M, Foti, G, Landoni, G, Andreossi, M, Annoni, A, Azzolini, M, Baiardo Redaelli, M, Belletti, A, Belmonte, G, Benigni, A, Benini, A, Bonfanti, P, Borghi, G, Butovska, L, Cadone Ughi, E, Calabria, M, Celona, S, Ciceri, F, Consalvo, L, Farina, A, Ferlicca, D, Finazzi, S, Fominskiy, E, Grieco, S, Guzzo, F, Landini, S, Lo-Catelli, S, Lorini, A, Lorini, G, Magri, F, Manildo, E, Nava, C, Ortalda, A, Palumbo, D, Real, G, Rezoagli, E, Ripa, C, Saracino, M, Sosio, S, Trocchia, R, Villa, M, Zangrillo, A, Lorini L. F., Labanca R., Bugada D., Cazzaniga S., D'Amico F., Grazioli L., Marmiere M., Novelli L., Pozzi M., Rona R., Giani M., Bellin V., Lucchini A., Raimondi F., Rocchi M., Salvioni M. T., Foti G., Landoni G., Andreossi M., Annoni A., Azzolini M. L., Baiardo Redaelli M., Belletti A., Belmonte G., Benigni A., Benini A., Bonfanti P., Borghi G., Butovska L., Cadone Ughi E., Calabria M., Celona S., Ciceri F., Consalvo L., Farina A., Ferlicca D., Finazzi S., Fominskiy E. V., Grieco S., Guzzo F., Landini S., Lo-Catelli S., Lorini A., Lorini G., Magri F., Manildo E., Nava C., Ortalda A., Palumbo D., Real G., Rezoagli E., Ripa C., Saracino M., Sosio S., Trocchia R., Villa M., and Zangrillo A.

Abstract

BACKGROUND: Lombardy was the epicenter of the first coronavirus disease 2019 (COVID-19) outbreak in western countries. The outbreak began in February 2020 and rapidly disseminated throughout the region. ICU beds were vastly insufficient and clinical knowledge of disease was poor at that time. Unfortunately, data on long-term mortality, morbidity, and Quality of Life are scarce and controversial. The aim of this study was to evaluate 1-year survival, Quality of Life, and functional recovery in patients with COVID-19 admitted to Intensive Care Units. METHODS: All COVID-19 patients invasively ventilated and successfully discharged from 3 important academic hospitals in Lombardy were evaluated. Evaluations were performed by qualified medical staff and monitoring over time was performed by telephone call. Functional, cognitive, and psychological outcomes were explored using validated questionnaires. Selected patients were offered a follow-up chest computed tomography (CT) scan. RESULTS: Four hundred twenty-seven patients were invasively ventilated and 268 (63%) were successfully discharged. Out of these 268 patients, 266 (99%) were alive at one year with no patient loss during follow-up. Very severe or severe dyspnea was reported by 7% of patients, while most patients (84%) did not experience dyspnea at rest. A small proportion of patients (17%) reported severe anxiety/depression. Good Quality of Life was reported by 64% of survivors. In patients complaining of dyspnea on exertion, fibrotic-like changes were observed at chest CT scans in 32/37 (86%) and 7/11 (63%) patients who underwent CT at 3 months and 1 year, respectively. CONCLUSIONS: COVID-19 patients discharged from the hospital after invasive ventilation had excellent one-year survival and good overall recovery and Quality of Life.

Published
2024

2. A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Author

Diego Palumbo, Alberto Zangrillo, Alessandro Belletti, Giorgia Guazzarotti, Maria Rosa Calvi, Francesca Guzzo, Renato Pennella, Giacomo Monti, Chiara Gritti, Marilena Marmiere, Margherita Rocchi, Sergio Colombo, Davide Valsecchi, Anna Mara Scandroglio, Lorenzo Dagna, Patrizia Rovere-Querini, Moreno Tresoldi, Giovanni Landoni, Francesco De Cobelli, Carolina Faustini, Nicolò Maimeri, Rosalba Lembo, Giuseppe Di Lucca, Raffaella Scotti, Maria Vittoria Lavorato, Alessandro Tomellieri, Corrado Campochiaro, Fatemeh Darvizeh, Francesca Calabrese, Roberto Mapelli, Nicola Pasculli, Giovanni Borghi, Antonella Cipriani, Maria Grazia Calabrò, Martina Crivellari, Annalisa Franco, Marina Pieri, Evgeny V. Fominskiy, Stefano Franchini, Antonio Dell'Acqua, Alessandro Marinosci, Giordano Vitali, Nicola Compagnone, Palumbo, D., Zangrillo, A., Belletti, A., Guazzarotti, G., Calvi, M. R., Guzzo, F., Pennella, R., Monti, G., Gritti, C., Marmiere, M., Rocchi, M., Colombo, S., Valsecchi, D., Scandroglio, A. M., Dagna, L., Rovere-Querini, P., Tresoldi, M., Landoni, G., De Cobelli, F., Faustini, C., Maimeri, N., Lembo, R., Di Lucca, G., Scotti, R., Lavorato, M. V., Tomellieri, A., Campochiaro, C., Darvizeh, F., Calabrese, F., Mapelli, R., Pasculli, N., Borghi, G., Cipriani, A., Calabro, M. G., Crivellari, M., Franco, A., Pieri, M., Fominskiy, E. V., Franchini, S., Dell'Acqua, A., Marinosci, A., Vitali, G., and Compagnone, N.

Subjects
ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, LR, likelihood ratio, Pneumomediastinum, Acute respiratory distress, Critical Care and Intensive Care Medicine, Article, Mechanical ventilation, Humans, Medicine, ARDS, acute respiratory distress syndrome, Mediastinal Emphysema, COVID-19, coronavirus disease 2019, PMD, pneumomediastinum, Respiratory Distress Syndrome, Chest imaging, Acute respiratory distress syndrome, SARS-CoV-2, business.industry, Tomography, X-ray computed, Pneumothorax, COVID-19, medicine.disease, PPV, positive predictive value, PNX, pneumothorax, NPV, negative predictive value, Case-Control Studies, Radiological weapon, Radiology, business
Abstract

Purpose: To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). Materials and methods: This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. Results: 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positives) demonstrated Macklin effect (p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Conclusions: Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.

Published
2021
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3. One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

Author

Marco Ripa, Alberto Zangrillo, Beatrice Righetti, Francesco De Cobelli, Pasquale Nardelli, Alessandro Ortalda, Maria Rosa Calvi, Giovanni Borghi, Evgeny Fominskiy, Filippo D'Amico, Alessandro Belletti, Moreno Tresoldi, Marco Saracino, Margherita Rocchi, Francesca Guzzo, Diego Palumbo, Giovanni Landoni, Marilena Marmiere, Lorenzo Dagna, Martina Baiardo Redaelli, Zangrillo, A., Belletti, A., Palumbo, D., Calvi, M. R., Guzzo, F., Fominskiy, E. V., Ortalda, A., Nardelli, P., Ripa, M., Baiardo Redaelli, M., Borghi, G., Landoni, G., D'Amico, F., Marmiere, M., Righetti, B., Rocchi, M., Saracino, M., Tresoldi, M., Dagna, L., and De Cobelli, F.

Subjects
Adult, ARDS, medicine.medical_specialty, post-intensive care syndrome, Activities of daily living, Adolescent, medicine.medical_treatment, intensive care unit, law.invention, coronavirus disease 2019, Quality of life, law, Activities of Daily Living, medicine, Humans, Depression (differential diagnoses), Mechanical ventilation, pulmonary fibrosis, SARS-CoV-2, business.industry, COVID-19, acute respiratory distress syndrome, medicine.disease, Respiration, Artificial, Intensive care unit, Intensive Care Units, Anesthesiology and Pain Medicine, quality of life, Emergency medicine, Anxiety, Observational study, Original Article, lung recovery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Objective Patients with COVID-19 frequently develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. Data on long-term survival of these patients are lacking. We investigated 1-year survival, quality of life and functional recovery of COVID-19 ARDS patients requiring invasive mechanical ventilation Design Prospective observational study Setting Tertiary-care university hospital Participants All COVID-19 ARDS patients receiving invasive mechanical ventilation and discharged alive from hospital Interventions Patients were contacted by phone after 1-year. Functional, cognitive, and psychological outcomes were explored through a questionnaire and assessed using validated scales. Patients were offered the possibility to undergo a follow-up chest CT scan. Measurements and Main Results The study included all adult (age ≥ 18 years) patients with COVID-19-related ARDS admitted to an ICU of our institution between February 25th, 2020 - April 27th, 2020), who received at least one day of invasive mechanical ventilation (IMV). Of 116 patients who received IMV, 61 (52.6%) survived to hospital discharge. These survivors were assessed one year after discharge and 56 completed a battery of tests of cognition, activities of daily living and interaction with family members. They had overall good functional recovery, with >80% reporting good recovery and no difficulties in usual activities. A total of 52 (93%) of patients had no dyspnea at rest. Severe anxiety/depression was reported by five (8.9%) of patients. Comparing 2-months and 1-year data, we observed the most significant improvements in the areas of working status and exertional dyspnea. One-year Chest CT scans were available for 36 patients: fibrotic-like changes were present in four patients. Conclusions All patients who survived the acute phase of the COVID-19 disease and were discharged from the hospital were alive at the 1-year follow up and the vast majority of them had good overall recovery and quality of life. Study Registration ClinicalTrials.gov NCT04318366

Published
2022

4. Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Author

Alessandro Belletti, Giordano Vitali, Lorenzo Dagna, Francesco De Cobelli, Nicolò Maimeri, Giacomo Monti, Antonio Dell'Acqua, Diego Palumbo, Sergio Colombo, Carolina Faustini, Anna Mara Scandroglio, Alberto Zangrillo, Giorgia Guazzarotti, Rosalba Lembo, Stefano Franchini, Giovanni Landoni, Alessandro Marinosci, Junaid Mushtaq, Renato Pennella, Evgeny Fominskiy, Belletti, A., Palumbo, D., Zangrillo, A., Fominskiy, E. V., Franchini, S., Dell'Acqua, A., Marinosci, A., Monti, G., Vitali, G., Colombo, S., Guazzarotti, G., Lembo, R., Maimeri, N., Faustini, C., Pennella, R., Mushtaq, J., Landoni, G., Scandroglio, A. M., Dagna, L., and De Cobelli, F.

Subjects
ARDS, pneumothorax, medicine.medical_treatment, mechanical ventilation, 030204 cardiovascular system & hematology, barotrauma, Logistic regression, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Macklin effect, medicine, Humans, Intubation, Pneumomediastinum, Mediastinal Emphysema, Original Research, Mechanical ventilation, SARS-CoV-2, business.industry, Incidence (epidemiology), COVID-19, acute respiratory distress syndrome, medicine.disease, Respiration, Artificial, Intensive care unit, Anesthesiology and Pain Medicine, Pneumothorax, Anesthesia, business, Cardiology and Cardiovascular Medicine
Abstract

Objective To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design Observational study. Setting Tertiary-care university hospital. Participants One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. Interventions The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. Measurements and Main Results PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). Conclusion PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.

Published
2021
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5. Prevalence, Characteristics, Risk Factors, and Outcomes of Invasively Ventilated COVID-19 Patients with Acute Kidney Injury and Renal Replacement Therapy

Author

Elena Moizo, Stefano Turi, Corrado Campochiaro, Alberto Zangrillo, Cristina Mattioli, Pasquale Nardelli, Paolo Silvani, Martina Crivellari, Giovanni Landoni, Marianna Sartorelli, Maria Grazia Calabrò, Fabio Ciceri, Francesco Giuseppe Nisi, Maria Luisa Azzolini, Giovanni Borghi, Marina Pieri, Antonio Dell'Acqua, Fabrizio Monaco, Martina Baiardo Redaelli, Caterina Conte, Alessandro Belletti, Ary Serpa Neto, Gabriele Valsecchi, Piera Angelillo, Evgeny Fominskiy, Cristina Barberio, Milena Mucci, Luigi Beretta, Rinaldo Bellomo, Anna Mara Scandroglio, Alfredo Ravizza, Stefano Tentori, Lorenzo Dagna, Giacomo Monti, Intensive Care Medicine, Fominskiy, E. V., Scandroglio, A. M., Monti, G., Calabro, M. G., Landoni, G., Dell'Acqua, A., Beretta, L., Moizo, E., Ravizza, A., Monaco, F., Campochiaro, C., Pieri, M., Azzolini, M. L., Borghi, G., Crivellari, M., Conte, C., Mattioli, C., Silvani, P., Mucci, M., Turi, S., Tentori, S., Baiardo Redaelli, M., Sartorelli, M., Angelillo, P., Belletti, A., Nardelli, P., Nisi, F. G., Valsecchi, G., Barberio, C., Ciceri, F., Serpa Neto, A., Dagna, L., Bellomo, R., and Zangrillo, A.

Subjects
Male, medicine.medical_specialty, Continuous Renal Replacement Therapy, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, 030232 urology & nephrology, Hospital mortality, 030204 cardiovascular system & hematology, urologic and male genital diseases, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Prevalence, medicine, Humans, Hospital Mortality, Renal replacement therapy, Stage (cooking), Aged, Ventilators, Mechanical, Coronavirus disease 2019, SARS-CoV-2, business.industry, urogenital system, Acute kidney injury, COVID-19, Hematology, General Medicine, Middle Aged, Tertiary care hospital, medicine.disease, Respiration, Artificial, Methods observational, female genital diseases and pregnancy complications, Coronavirus, Critical care, Treatment Outcome, Nephrology, Emergency medicine, Female, business, Research Article, Healthcare system
Abstract

Background: There is no information on acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) among invasively ventilated coronavirus disease 2019 (COVID-19) patients in Western healthcare systems. Objective: To study the prevalence, characteristics, risk factors and outcome of AKI and CRRT among invasively ventilated COVID-19 patients. Methods: Observational study in a tertiary care hospital in Milan, Italy. Results: Among 99 patients, 72 (75.0%) developed AKI and 17 (17.7%) received CRRT. Most of the patients developed stage 1 AKI (33 [45.8%]), while 15 (20.8%) developed stage 2 AKI and 24 (33.4%) a stage 3 AKI. Patients who developed AKI or needed CRRT at latest follow-up were older, and among CRRT treated patients a greater proportion had preexisting CKD. Hospital mortality was 38.9% for AKI and 52.9% for CRRT patients. Conclusions: Among invasively ventilated COVID-19 patients, AKI is very common and CRRT use is common. Both carry a high risk of in-hospital mortality.

Published
2021

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