Scendoni Roberto, Gattari Diego, Cingolani Mariano
Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
Anesthesia and Resuscitation Unit, ASUR Marche AV3, Macerata, Italy.
Clin Pathol. 2022 Mar 4;15:2632010X221083223. doi: 10.1177/2632010X221083223. eCollection 2022 Jan-Dec.
Acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19) is a serious complication that requires early recognition. Autopsy reports or biopsies of the lungs in patients with COVID-19 revealed diffuse alveolar damage (DAD) at different stages; the fibrotic phase is usually associated with long-standing severe disease. Care management of hospitalized patients is not easy, given that the risk of incurring a ventilator-induced lung injury (VILI) is high. Additionally, if the patient develops nosocomial infections, sepsis-induced ARDS should be considered in the study of the pathophysiological processes. We present an autopsy case of a hospitalized patient whose death was linked to COVID-19 infection, with the histopathological pattern of advanced pulmonary fibrosis. After prolonged use of non-invasive and invasive ventilation, the patient developed polymicrobial superinfection oh the lungs. After analyzing the individual's clinical history and pulmonary anatomopathological findings, we consider healthcare issues that should lead to an improvement in diagnosis and to more adequate standards of care management among health professionals.
由冠状病毒病（COVID-19）引起的急性呼吸窘迫综合征（ARDS）是一种需要早期识别的严重并发症。COVID-19患者的尸检报告或肺活检显示在不同阶段存在弥漫性肺泡损伤（DAD）；纤维化阶段通常与长期的严重疾病相关。鉴于发生呼吸机诱导性肺损伤（VILI）的风险很高，对住院患者的护理管理并不容易。此外，如果患者发生医院感染，在病理生理过程研究中应考虑脓毒症诱导的ARDS。我们报告一例住院患者的尸检病例，其死亡与COVID-19感染有关，具有晚期肺纤维化的组织病理学特征。在长时间使用无创和有创通气后，该患者发生了肺部多重微生物重叠感染。在分析了该个体的临床病史和肺部解剖病理学发现后，我们思考了一些医疗问题，这些问题应能改善诊断，并使医护人员的护理管理标准更加恰当。
