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An Italian firm, led by Sant’Orsola in Bologna, describe the mechanism responsible for the high mortality in intensive care of patients with Covid-19. Two simple exams identify this condition whose early diagnosis, together with the support of the highest possible care in intensive care, can provide a decrease in mortality up to 50%. Published in the Lancet Respiratory Medicine on August 27, the study shows that the virus can damage both parts of the lung: the alveoli (the units of the lung that absorb oxygen and release carbon dioxide) and capillaries (the blood vessels where the exchange between carbon dioxide and oxygen takes place). When the virus damages both the alveoli and the pulmonary capillaries, almost 60% of patients die. When the virus damages the alveoli or capillaries, just over 20% of patients die. The “phenotype” of patients in whom the virus damages both the alveoli and the capillaries (patients with “double damage”) is easily identifiable by measuring a lung function parameter (lung compliance 40; normal value 100) and a blood chemistry parameter (D-dimer> 1800; normal value 10).
These findings have important implications for both currently available treatments and future studies of new therapeutic interventions for patients with Covid-19. In fact, today the rapid recognition of the “double damage” phenotype will allow a much higher diagnostic precision and an even more effective use of therapies, reserving the more “aggressive” therapeutic measures such as mechanical ventilation, extracorporeal membrane for these patients. oxygenation (Ecmo) and therapeutic environments with higher intensity of care such as intensive care, treatment of patients with “single injury” with non-invasive ventilation with a helmet and admission to sub-intensive care. In the future, these results will allow a rapid identification of patients in whom to try experimental anticoagulant treatments to avoid damage to the pulmonary capillaries. The study was carried out in 301 patients admitted to the Sant’Orsola Polyclinic in Bologna, the Modena Polyclinic, the Ospedale Maggiore, the Niguarda and the Humanitas Clinical Institute in Milan, the San Gerardo de Monza Hospital and the Polyclinic. Gemini from Rome.
Last Updated: Monday, August 31, 2020, 3:18 PM
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