tetano
Editor, Senior Moderator
Respiration
. 2020 Aug 5;1-11.
doi: 10.1159/000509007. Online ahead of print.
Inpatient Care during the COVID-19 Pandemic: A Survey of Italian Physicians
Marina Attanasi[SUP] 1 [/SUP], Simone Pasini[SUP] 2 [/SUP], Antonio Caronni[SUP] 3 [/SUP], Giulia Michela Pellegrino[SUP] 4 5 [/SUP], Paola Faverio[SUP] 6 7 [/SUP], Sabrina Di Pillo[SUP] 1 [/SUP], Matteo Maria Cimino[SUP] 8 [/SUP], Giuseppe Cipolla[SUP] 9 [/SUP], Francesco Chiarelli[SUP] 1 [/SUP], Stefano Centanni[SUP] 4 [/SUP], Giuseppe Francesco Sferrazza Papa[SUP] 10 11 [/SUP], Collaborators for the RECOVER Investigators Study Group
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern.
Objective: We explored the clinical management of inpatients with COVID-19 in Italy.
Methods: A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed.
Results: A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%.
Conclusions: In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.
Keywords: Acute respiratory failure; COVID-19; Mechanical ventilation; Pandemic; Pneumonia; Rehabilitation; Steroid.
. 2020 Aug 5;1-11.
doi: 10.1159/000509007. Online ahead of print.
Inpatient Care during the COVID-19 Pandemic: A Survey of Italian Physicians
Marina Attanasi[SUP] 1 [/SUP], Simone Pasini[SUP] 2 [/SUP], Antonio Caronni[SUP] 3 [/SUP], Giulia Michela Pellegrino[SUP] 4 5 [/SUP], Paola Faverio[SUP] 6 7 [/SUP], Sabrina Di Pillo[SUP] 1 [/SUP], Matteo Maria Cimino[SUP] 8 [/SUP], Giuseppe Cipolla[SUP] 9 [/SUP], Francesco Chiarelli[SUP] 1 [/SUP], Stefano Centanni[SUP] 4 [/SUP], Giuseppe Francesco Sferrazza Papa[SUP] 10 11 [/SUP], Collaborators for the RECOVER Investigators Study Group
Affiliations
- PMID: 32756065
- DOI: 10.1159/000509007
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern.
Objective: We explored the clinical management of inpatients with COVID-19 in Italy.
Methods: A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed.
Results: A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%.
Conclusions: In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.
Keywords: Acute respiratory failure; COVID-19; Mechanical ventilation; Pandemic; Pneumonia; Rehabilitation; Steroid.