Positive airway pressure longer than 24 h is associated with histopathological volutrauma in severe COVID-19 pneumonia—an ESGFOR based narrative case-control review

SARS-CoV-2; Post-mortem microbiology; Volutrauma SARS-CoV-2; Microbiología post mortem; Volutrauma SARS-CoV-2; Microbiologia post mortem; Volutrauma Background and Objective: A thorough understanding of the pathogenic mechanisms elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still requires further research. Until recently, only a restricted number of autopsies have been performed, therefore limiting the accurate knowledge of the lung injury associated with SARS-CoV-2. A multidisciplinary European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group of Forensic and Post-mortem Microbiology-ESGFOR team conducted a non-systematic narrative literature review among coronavirus 2019 disease (COVID-19) pneumonia cases assessing the histopathological (HP) effects of positive airways pressure. HP lung features were recorded and compared between mechanically ventilated (>24 hours) and control (ventilation 24 hours as an independent variable associated with DAD (OR =5.40, 95% CI: 1.48–19.62), fibrosis (OR =3.88, 95% CI: 1.25–12.08), vascular damage (OR =5.49, 95% CI: 1.78–16.95) and association of DAD plus fibrosis plus vascular damage (OR =6.99, 95% CI: 2.04–23.97). Conclusions: We identified that patients mechanically ventilated >24 hours had a significantly higher rate of pulmonary injury on histopathology independently of age and gender. Our findings emphasize the importance of maintaining a protective ventilator strategy when subjects with COVID-19 pneumonia undergo intubation.