Vita-Salute San Raffaele University, Milan, Italy.; Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Unit of Anesthesiology and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Unit of Anesthesiology and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.; Unit of Anesthesiology and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy.

Severe Coronavirus disease 2019 (COVID-19) is characterized by acute respiratory distress syndrome (ARDS) which may lead to long-lasting pulmonary sequelae in the survivors. COVID-19 shares common molecular signatures with interstitial lung diseases (ILDs), including pro-angiogenic and tissue-remodeling mechanisms mediated by vascular endothelial growth factor receptor (VEGF-R), fibroblast growth factor receptor (FGF-R), and platelet-derived growth factor receptor (PDGF-R). Nintedanib mainly targets these factors and is approved for ILDs. Therefore, we administered nintedanib through compassionate use to three patients with COVID-19 pneumonia requiring extra-corporeal membrane-oxygenation (ECMO). Here, we describe our experience in an attempt to explore the role of nintedanib in lung recovery in COVID-19. Three obese patients aged between 42 and 52 years were started on nintedanib due to difficulty in obtaining lung function restoration and weaning from ECMO support following the

2021-11-17

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.CN - COVID-BioB Study Group

OBJECTIVE: To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN: Observational study. SETTING: Tertiary-care university hospital. PARTICIPANTS: One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. INTERVENTIONS: The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. MEASUREMENTS AND MAIN RESULTS: PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not.

2021-10-12

Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.CN - COVID-BioB Study Group

PURPOSE: To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS: This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020-December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. RESULTS: 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1-18]

2021-09-01

GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy. Electronic address: giannini_fra@yahoo.it.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; Guglielmo da Saliceto Hospital, Piacenza, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; Guglielmo da Saliceto Hospital, Piacenza, Italy.; Guglielmo da Saliceto Hospital, Piacenza, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; IRCCS San Raffaele Scientific Institute, Italy.; Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy.; Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; Ospedale di Cremona, Cremona, Italy.; Ospedale di Cremona, Cremona, Italy.; Ospedale di Cremona, Cremona, Italy.; Centro Cardiologico Monzino IRCCS, Milano, Italy.; Centro Cardiologico Monzino IRCCS, Milano, Italy.; Centro Cardiologico Monzino IRCCS, Milano, Italy.; Ospedale Maggiore, Bologna, Italy.; Ospedale Maggiore, Bologna, Italy.; Ospedale Maggiore, Bologna, Italy.; San Gerardo Hospital, Monza, Italy.; San Gerardo Hospital, Monza, Italy.; San Gerardo Hospital, Monza, Italy.; ASST Bolognini Hospital, Bergamo Est, Italy.; ASST Bolognini Hospital, Bergamo Est, Italy.; ASST Bolognini Hospital, Bergamo Est, Italy.; Parma University Hospital, Parma, Italy.; Parma University Hospital, Parma, Italy.; Parma University Hospital, Parma, Italy.; ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy.; ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy.; ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy.; San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.; San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.; San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Casa di Cura Villa dei Pini, Civitanova Marche, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; Casa di Cura Villa dei Pini, Civitanova Marche, Italy.; ICC Istituto Clinico Casalpalocco, Rome, Italy.; ICC Istituto Clinico Casalpalocco, Rome, Italy.; San L. Mandic Hospital, Merate, Italy.; San L. Mandic Hospital, Merate, Italy.; San L. Mandic Hospital, Merate, Italy.; ASST Papa Giovanni XXIII, Bergamo, Italy.; ASST Papa Giovanni XXIII, Bergamo, Italy.; ASST Papa Giovanni XXIII, Bergamo, Italy.; ASST Papa Giovanni XXIII, Bergamo, Italy.; IRCCS San Raffaele Scientific Institute, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.; IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. OBJECTIVES: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. METHODS: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together