the ‘lethal’ mechanism in intensive care

When the new coronavirus manages to double the damage lung, which affects both capillaries and alveoli, the risk of death in patients admitted to intensive care increases considerably. But two clinical examinations and the support of maximum intensive care are enough to reduce mortality by up to 50%. This is the problem, and also the solution, at the heart of the Italian study published in ‘Lancet respiratory medicine’, which describes the mechanism responsible for the high mortality in intensive care of patients with Covid at the Sant’Orsola Polyclinic in Bologna. Franco Locatelli from the Bambino Gesù hospital, president of the Higher Health Council (Css) and member of the Scientific Technical Committee (Cts) for the coronavirus emergency also participated in the study.

Coronavirus, double damage to the lung

In detail, the study shows that the virus can damage both components of the lung: the alveoli (the units of the lung that absorb oxygen and release carbon dioxide) and i 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 withdouble to damage‘) is easily identifiable by measuring a lung function parameter and a blood chemistry parameter.

The study results, according to the researchers, have important implications for both currently available treatments and future studies on new therapeutic interventions for patients with Covid-19. In fact, today the rapid recognition of the ‘double damage’ phenotype will allow much greater diagnostic precision and an even more effective use of therapies, reserving the more ‘aggressive’ therapeutic measures such as mechanical ventilation, extracorporeal membrane oxygenation for these patients. (Ecmo) and therapeutic environments with higher intensity of care such as intensive care), treating patients with ‘single damage’ with non-invasive ventilation via helmet and admission to sub-intensive care.

In the future, in addition, this data will allow you to quickly identify patients for testing. deals experimental with anticoagulants to avoid damage to the pulmonary capillaries. The study was carried out in 301 patients hospitalized in Sant’Orsola in Bologna, in the Policlinico di Modena, in the Maggiore hospital, in Niguarda and in the Humanitas Clinical Institute in Milan, in the San Gerardo hospital in Monza and in the hospital Gemelli in Rome. . The research is coordinated by Marco Ranieri, director of anesthesia and multipurpose intensive care at Sant’Orsola Polyclinic. In addition to the participation in the Locatelli study, collaboration between different disciplines (anesthesia and resuscitation, pulmonology, radiology, onco-hematology, medical statistics) and several Italian universities (University of Bologna, University of Modena and Reggio Emilia, University of Milan , University of Milano-Bicocca, University of Turin, Humanitas University, Catholic University of the Sacred Heart) and abroad (Free University of Bruxelles, University of Ireland Galway and University of Toronto).