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

Veroniek Saegeman; Marta C Cohen; Lydia Abasolo; Jordi Rello; Benjamin Fernandez-Gutierrez; Amparo Fernandez-Rodriguez

doi:10.21037/atm-22-605

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

Ann Transl Med. 2022 Jun;10(11):644. doi: 10.21037/atm-22-605.

Authors

Veroniek Saegeman^#^{1

2}, Marta C Cohen^#³, Lydia Abasolo⁴, Jordi Rello^#^{5

6

7}, Benjamin Fernandez-Gutierrez^#⁸, Amparo Fernandez-Rodriguez⁹

Affiliations

¹ Department of Microbiology and Infection Control, Vitaz, Sint-Niklaas, Belgium.
² Department of Infection Control, University Hospitals, Leuven, Belgium.
³ Histopathology Department, Sheffield Children's NHS FT, Sheffield, UK.
⁴ Rheumatology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
⁵ Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
⁶ Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
⁷ Clinical Research, CHRU Nimes, Nimes, France.
⁸ Rheumatology Department, Hospital Clinico San Carlos, Madrid, Spain.
⁹ Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.

^# Contributed equally.

Abstract

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) patients. A logistic regression analysis was performed to identify associations between mechanical ventilation (MV) and HP findings.

Methods: A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021.

Key content and findings: 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).

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.

Keywords: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); mechanical ventilation (MV); pathology; post-mortem microbiology; volutrauma.

Publication types

Review