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Tonelli R, Marchioni A, Tabbì L, Fantini R, Busani S, Castaniere I, Andrisani D, Gozzi F, Bruzzi G, Manicardi L, Demurtas J, Andreani A, Cappiello GF, Samarelli AV, Clini E. 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; 10:975. [PMID: 33801368 PMCID: PMC7958611 DOI: 10.3390/jcm10050975] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 01/08/2023] Open
Abstract
The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual's excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type.
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Affiliation(s)
- Roberto Tonelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Luca Tabbì
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Riccardo Fantini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Stefano Busani
- Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Ivana Castaniere
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Dario Andrisani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Filippo Gozzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Giulia Bruzzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Linda Manicardi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
- Primary Care Department USL Toscana Sud Est-Grosseto, 58100 Grosseto, Italy
| | - Alessandro Andreani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Gaia Francesca Cappiello
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Anna Valeria Samarelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Enrico Clini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
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Spinelli E, Marongiu I, Mauri T. Control of Respiratory Drive by Noninvasive Ventilation as an Early Predictor of Success. Am J Respir Crit Care Med 2020; 202:1737-1738. [PMID: 32945689 PMCID: PMC7737590 DOI: 10.1164/rccm.202007-2928le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elena Spinelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy and
| | | | - Tommaso Mauri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy and.,University of Milan Milan, Italy
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