COVID-19 pneumonia: pathophysiology and management

Area of Science:

• Pulmonology
• Critical Care Medicine
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) pneumonia presents unique pathophysiological challenges.
• Early stages are characterized by severe hypoxemia with near-normal lung imaging and mechanics, suggesting altered perfusion.

Purpose of the Study:

• To describe the evolution of COVID-19 pneumonia's pathophysiologic characteristics over time.
• To correlate these changes with necessary treatment modifications.

Main Methods:

• Observational analysis of COVID-19 pneumonia progression through different care settings (Emergency Department, High-Dependency Unit, Intensive Care Unit).
• Assessment of respiratory mechanics, gas exchange, lung imaging, and response to interventions like PEEP and prone positioning.

Main Results:

• Early ED phase: severe hypoxemia, normal respiratory mechanics, altered lung perfusion, lack of PEEP prerequisites.
• HDU phase: potential worsening, development of edema/atelectasis, indication for non-invasive support or mechanical ventilation to prevent patient self-inflicted lung injury (P-SILI).
• ICU phase: progression to lung fibrosis, impaired mechanics, increased PaCO2, decreased responsiveness to PEEP and prone positioning.

Conclusions:

• COVID-19 pneumonia pathophysiology changes dynamically, necessitating adaptive treatment strategies.
• Understanding temporal changes is crucial for optimizing patient management from early hypoxemia to advanced fibrotic stages.