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- Title
What Open-Lung Biopsy Teaches Us about ARDS in COVID-19 Patients: Mechanisms, Pathology, and Therapeutic Implications.
- Authors
Abourida, Yassamine; Rebahi, Houssam; Chichou, Hajar; Fenane, Hicham; Msougar, Yassine; Fakhri, Anas; Hazmiri, Fatima Ezzahra; Ismail, Ayman; Rais, Hanane; Soraa, Nabila; Samkaoui, Mohammed Abdenasser
- Abstract
Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients' specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.
- Subjects
THERAPEUTIC use of glucocorticoids; ADULT respiratory distress syndrome treatment; HYPOXEMIA; ANTICOAGULANTS; ARTIFICIAL respiration; BIOPSY; INTENSIVE care units; POLYMERASE chain reaction; ADULT respiratory distress syndrome; REVERSE transcriptase polymerase chain reaction; THORACOTOMY; COVID-19
- Publication
BioMed Research International, 2020, p1
- ISSN
2314-6133
- Publication type
Article
- DOI
10.1155/2020/2909673