PDF(Pubmed)
Abstract：
UNASSIGNED: 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) patients. A logistic regression analysis was performed to identify associations between mechanical ventilation (MV) and HP findings.
UNASSIGNED: A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021.
UNASSIGNED: Seventy patients (median age: 69 years) from 24 studies were analysed, among whom 38 (54.2%) underwent MV longer than 24 hours. Overall, main HP features were: diffuse alveolar damage (DAD) in 53 (75.7%), fibrosis (interstitial/intra-alveolar) in 43 (61.4%), vascular damage-including thrombosis/emboli- in 41 (58.5%), and endotheliitis in only 8 (11.4%) patients. Association of DAD, fibrosis and vascular damage was detected in 30 (42.8%) patients. Multivariate analysis, adjusted by age and gender, identified MV >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).
UNASSIGNED: 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.
UNASSIGNED: A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021.
UNASSIGNED: Seventy patients (median age: 69 years) from 24 studies were analysed, among whom 38 (54.2%) underwent MV longer than 24 hours. Overall, main HP features were: diffuse alveolar damage (DAD) in 53 (75.7%), fibrosis (interstitial/intra-alveolar) in 43 (61.4%), vascular damage-including thrombosis/emboli- in 41 (58.5%), and endotheliitis in only 8 (11.4%) patients. Association of DAD, fibrosis and vascular damage was detected in 30 (42.8%) patients. Multivariate analysis, adjusted by age and gender, identified MV >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).
UNASSIGNED: 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.
摘要：
■对严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）引起的致病机制的透彻了解仍需要进一步研究。直到最近,只进行了有限数量的尸检，因此限制了与SARS-CoV-2相关的肺损伤的准确知识。一个多学科的欧洲临床微生物学和传染病学会（ESCMID）法医和死后微生物学研究小组-ESGFOR团队对2019年冠状病毒疾病（COVID-19）肺炎病例进行了非系统的叙述性文献综述，评估了组织病理学（HP）积极气道压力的影响。记录HP肺部特征，并比较机械通气（>24小时）和对照组（通气<24小时）患者之间的差异。进行逻辑回归分析以确定机械通气（MV）和HP结果之间的关联。
■进行了PubMed和MEDLINE搜索，以确定2020年3月1日至2021年6月30日之间发表的研究。
■分析了24项研究中的70名患者（中位年龄：69岁），其中38人(54.2%)接受MV超过24小时。总的来说,主要表现为：弥漫性肺泡损伤（DAD）53例（75.7%），纤维化（间质/肺泡内）43（61.4%），血管损伤-包括血栓形成/栓塞-41（58.5％），仅有8例(11.4%)患者出现内皮炎。DAD协会,在30例(42.8%)患者中检测到纤维化和血管损伤。多变量分析，按年龄和性别调整，将MV>24小时确定为与DAD相关的自变量(OR=5.40，95%CI：1.48-19.62)，纤维化（OR=3.88，95%CI：1.25-12.08），血管损害(OR=5.49,95%CI:1.78-16.95)与DAD+纤维化+血管损害的相关性(OR=6.99,95%CI:2.04-23.97)。
■我们发现机械通气>24小时的患者在组织病理学上的肺损伤发生率明显较高，与年龄和性别无关。我们的发现强调了当COVID-19肺炎患者接受插管时，保持保护性呼吸机策略的重要性。
■进行了PubMed和MEDLINE搜索，以确定2020年3月1日至2021年6月30日之间发表的研究。
■分析了24项研究中的70名患者（中位年龄：69岁），其中38人(54.2%)接受MV超过24小时。总的来说,主要表现为：弥漫性肺泡损伤（DAD）53例（75.7%），纤维化（间质/肺泡内）43（61.4%），血管损伤-包括血栓形成/栓塞-41（58.5％），仅有8例(11.4%)患者出现内皮炎。DAD协会,在30例(42.8%)患者中检测到纤维化和血管损伤。多变量分析，按年龄和性别调整，将MV>24小时确定为与DAD相关的自变量(OR=5.40，95%CI：1.48-19.62)，纤维化（OR=3.88，95%CI：1.25-12.08），血管损害(OR=5.49,95%CI:1.78-16.95)与DAD+纤维化+血管损害的相关性(OR=6.99,95%CI:2.04-23.97)。
■我们发现机械通气>24小时的患者在组织病理学上的肺损伤发生率明显较高，与年龄和性别无关。我们的发现强调了当COVID-19肺炎患者接受插管时，保持保护性呼吸机策略的重要性。
