Saegeman Veroniek, Cohen Marta C, Abasolo Lydia, Rello Jordi, Fernandez-Gutierrez Benjamin, Fernandez-Rodriguez Amparo
Department of Microbiology and Infection Control, Vitaz, Sint-Niklaas, Belgium.
Department of Infection Control, University Hospitals, Leuven, Belgium.
Ann Transl Med. 2022 Jun;10(11):644. doi: 10.21037/atm-22-605.
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.
A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021.
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).
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.
全面了解严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发的致病机制仍需进一步研究。直到最近，仅进行了数量有限的尸检，因此限制了对与SARS-CoV-2相关的肺损伤的准确认识。欧洲临床微生物学和传染病学会（ESCMID）法医与尸检微生物学多学科研究小组-ESGFOR团队对2019冠状病毒病（COVID-19）肺炎病例进行了非系统性叙述性文献综述，评估气道正压通气的组织病理学（HP）影响。记录并比较了机械通气时间>24小时的患者和对照组（通气时间<24小时）患者的HP肺部特征。进行了逻辑回归分析，以确定机械通气（MV）与HP结果之间的关联。
在PubMed和MEDLINE上进行检索，以识别2020年3月1日至2021年6月三十日期间发表的研究。
对来自24项研究的70例患者（中位年龄：69岁）进行了分析，其中38例（54.2%）接受了超过24小时的MV。总体而言，主要的HP特征为：53例（75.7%）出现弥漫性肺泡损伤（DAD），43例（61.4%）出现纤维化（间质/肺泡内）,41例（58.5%）出现血管损伤，包括血栓形成/栓子，仅8例（11.4%）患者出现内皮炎。30例（42.8%）患者检测到DAD、纤维化和血管损伤相关联。经年龄和性别校正的多变量分析确定，MV>24小时是与DAD（比值比=5.40，95%置信区间：1.48-19.62）、纤维化（比值比=3.88，95%置信区间：1.25-12.08）、血管损伤（比值比=5.49，95%置信区间：1.78-16.95）以及DAD加纤维化加血管损伤相关联（比值比=6.99，95%置信区间：2.04-23.97）的独立变量。
我们发现，机械通气>24小时的患者在组织病理学上出现肺部损伤的发生率显著更高，且与年龄和性别无关。我们的研究结果强调了COVID-19肺炎患者插管时维持保护性通气策略的重要性。
