Understanding the pathophysiology of typical acute respiratory distress syndrome and severe COVID-19

ABSTRACT Introduction Typical acute respiratory distress syndrome (ARDS) and severe coronavirus-19 (COVID-19) pneumonia share complex pathophysiology, a high mortality rate, and an unmet need for efficient therapeutics. Areas covered This review discusses the current advances in understanding the pathophysiologic mechanisms underlying typical ARDS and severe COVID-19 pneumonia, highlighting specific aspects of COVID-19-related acute hypoxemic respiratory failure that require attention. Two models have been proposed to describe the mechanisms of respiratory failure associated with typical ARDS and severe COVID-19 pneumonia. Expert opinion ARDS is defined as a syndrome rather than a distinct pathologic entity. There is great heterogeneity regarding the pathophysiologic, clinical, radiologic, and biological phenotypes in patients with ARDS, challenging clinicians, and scientists to discover new therapies. COVID-19 has been described as a cause of pulmonary ARDS and has reopened many questions regarding the pathophysiology of ARDS itself. COVID-19 lung injury involves direct viral epithelial cell damage and thrombotic and inflammatory reactions. There are some differences between ARDS and COVID-19 lung injury in aspects of aeration distribution, perfusion, and pulmonary vascular responses.

[1]  A. Aliverti,et al.  Lung Response to a Higher Positive End-Expiratory Pressure in Mechanically Ventilated Patients With COVID-19 , 2021, Chest.

[2]  L. Gattinoni,et al.  Isn’t it time to abandon ARDS? The COVID-19 lesson , 2021, Critical Care.

[3]  J. Laffey,et al.  Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial , 2021, The Lancet Respiratory Medicine.

[4]  G. Grasselli,et al.  Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis , 2021, Critical Care.

[5]  J. Laffey,et al.  Personalized mechanical ventilation in acute respiratory distress syndrome , 2021, Critical Care.

[6]  P. Pelosi,et al.  Extension of Collagen Deposition in COVID-19 Post Mortem Lung Samples and Computed Tomography Analysis Findings , 2021, International journal of molecular sciences.

[7]  P. Pelosi,et al.  Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study , 2021, Critical Care.

[8]  Assessment of Lung Reaeration at 2 Levels of Positive End-expiratory Pressure in Patients With Early and Late COVID-19-related Acute Respiratory Distress Syndrome , 2021, Journal of thoracic imaging.

[9]  Huiyan Sun,et al.  Clinical Significance of Plasma D-Dimer in COVID-19 Mortality , 2021, Frontiers in Medicine.

[10]  M. Netea,et al.  The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity , 2021, The Lancet Respiratory Medicine.

[11]  M. Antonelli,et al.  Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients , 2021, Critical Care.

[12]  B. Matta,et al.  Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study , 2021, Critical Care.

[13]  P. Pelosi,et al.  Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19 , 2021, Expert review of respiratory medicine.

[14]  M. Biehl,et al.  Severe covid-19 pneumonia: pathogenesis and clinical management , 2021, BMJ.

[15]  P. Pelosi,et al.  Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia , 2021, Critical Care.

[16]  P. Pelosi,et al.  Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study , 2021, Journal of clinical medicine.

[17]  L. Lorini,et al.  The impact of ventilation–perfusion inequality in COVID-19: a computational model , 2021, Journal of applied physiology.

[18]  J. Laffey,et al.  Precision medicine in acute respiratory distress syndrome: workshop report and recommendations for future research , 2020, European Respiratory Review.

[19]  T. Wakefield,et al.  Venous thrombosis epidemiology, pathophysiology, and anticoagulant therapies and trials in severe acute respiratory syndrome coronavirus 2 infection , 2020, Journal of Vascular Surgery: Venous and Lymphatic Disorders.

[20]  H. Reinecke,et al.  Myocardial injury in severe COVID‐19 is similar to pneumonias of other origin: results from a multicentre study , 2020, ESC heart failure.

[21]  D. Wichmann.  Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 , 2020, Annals of Internal Medicine.

[22]  P. Pelosi,et al.  Effects of higher PEEP and recruitment manoeuvres on mortality in patients with ARDS: a systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials , 2020, Intensive Care Medicine Experimental.

[23]  H. Moch,et al.  Higher prevalence of pulmonary macrothrombi in SARS‐CoV‐2 than in influenza A: autopsy results from ‘Spanish flu’ 1918/1919 in Switzerland to Coronavirus disease 2019 , 2020, The journal of pathology. Clinical research.

[24]  Natalia Zubieta-DeUrioste,et al.  Pneumolysis and “Silent Hypoxemia” in COVID-19 , 2020, Indian Journal of Clinical Biochemistry.

[25]  M. Kuiper,et al.  Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study , 2020, The Lancet Respiratory Medicine.

[26]  J. Marini,et al.  Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study , 2020, Intensive Care Medicine.

[27]  P. Pelosi,et al.  Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems , 2020, Virchows Archiv.

[28]  Kusal K. Das,et al.  COVID-19 and Pneumolysis Simulating Extreme High-altitude Exposure with Altered Oxygen Transport Physiology; Multiple Diseases, and Scarce Need of Ventilators: Andean Condor's-eye-view. , 2020, Reviews on recent clinical trials.

[29]  A. Engström‐Làurent,et al.  Presence of hyaluronan in lung alveoli in severe Covid-19: An opening for new treatment options? , 2020, The Journal of Biological Chemistry.

[30]  Keith Sigel,et al.  An inflammatory cytokine signature predicts COVID-19 severity and survival , 2020, Nature Medicine.

[31]  P. Libby,et al.  COVID-19 is, in the end, an endothelial disease , 2020, European heart journal.

[32]  R. Fiocca,et al.  Lung fibrosis: an undervalued finding in COVID-19 pathological series , 2020, The Lancet Infectious Diseases.

[33]  P. Pelosi,et al.  Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2 , 2020, Expert review of respiratory medicine.

[34]  P. Pelosi,et al.  Bloodstream infections in critically ill patients with COVID‐19 , 2020, European journal of clinical investigation.

[35]  Andrea Gianatti,et al.  Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study , 2020, The Lancet Infectious Diseases.

[36]  Axel Haverich,et al.  Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. , 2020, The New England journal of medicine.

[37]  F. Martinez,et al.  Severe Covid-19. , 2020, The New England journal of medicine.

[38]  E. Adrario,et al.  Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective , 2020, Critical Care.

[39]  P. Pelosi,et al.  Distinct phenotypes require distinct respiratory management strategies in severe COVID-19 , 2020, Respiratory Physiology & Neurobiology.

[40]  K. Mertz,et al.  Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction , 2020, Histopathology.

[41]  Matthew D. Li,et al.  Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT , 2020, The Lancet Infectious Diseases.

[42]  Carlos Del Rio,et al.  Mild or Moderate Covid-19. , 2020, The New England journal of medicine.

[43]  G. Grasselli,et al.  Potential for Lung Recruitment and Ventilation-Perfusion Mismatch in Patients With the Acute Respiratory Distress Syndrome From Coronavirus Disease 2019* , 2020, Critical care medicine.

[44]  L. Camporota,et al.  COVID-19 pneumonia: different respiratory treatments for different phenotypes? , 2020, Intensive Care Medicine.

[45]  D. Gommers,et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19 , 2020, Thrombosis Research.

[46]  S. Rees,et al.  Changes in shunt, ventilation/perfusion mismatch, and lung aeration with PEEP in patients with ARDS: a prospective single-arm interventional study , 2020, Critical Care.

[47]  S. Inui,et al.  Chest CT Findings in Cases from the Cruise Ship Diamond Princess with Coronavirus Disease (COVID-19) , 2020, Radiology. Cardiothoracic imaging.

[48]  P. Pelosi,et al.  Influence of Positive End-Expiratory Pressure Titration on the Effects of Pronation in Acute Respiratory Distress Syndrome: A Comprehensive Experimental Study , 2020, Frontiers in Physiology.

[49]  Zunyou Wu,et al.  Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. , 2020, JAMA.

[50]  B. Souweine,et al.  Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. , 2019, The Lancet. Respiratory medicine.

[51]  J. Laffey,et al.  Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. , 2018, The Lancet. Respiratory medicine.

[52]  M. Amato,et al.  Esophageal Manometry and Regional Transpulmonary Pressure in Lung Injury , 2018, American journal of respiratory and critical care medicine.

[53]  P. Pelosi,et al.  Acute exacerbation of idiopathic pulmonary fibrosis: lessons learned from acute respiratory distress syndrome? , 2018, Critical Care.

[54]  P. Parsons,et al.  Stability of ARDS subphenotypes over time in two randomised controlled trials , 2018, Thorax.

[55]  P. Pelosi,et al.  Lung imaging: how to get better look inside the lung. , 2017, Annals of translational medicine.

[56]  T. van der Poll,et al.  Identification and validation of distinct biological phenotypes in patients with acute respiratory distress syndrome by cluster analysis , 2017, Thorax.

[57]  K. Famous,et al.  Acute Respiratory Distress Syndrome Subphenotypes Respond Differently to Randomized Fluid Management Strategy , 2016, American journal of respiratory and critical care medicine.

[58]  M. Andreeff,et al.  Comparative Effects of Volutrauma and Atelectrauma on Lung Inflammation in Experimental Acute Respiratory Distress Syndrome , 2016, Critical care medicine.

[59]  A. Esteban,et al.  Should ARDS be renamed diffuse alveolar damage? , 2016, Intensive Care Medicine.

[60]  Anders Larsson,et al.  Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. , 2016, JAMA.

[61]  Kevin Delucchi,et al.  Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. , 2014, The Lancet. Respiratory medicine.

[62]  A. Esteban,et al.  Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies. , 2013, The Lancet. Respiratory medicine.

[63]  S. Jaber,et al.  Prone positioning in severe acute respiratory distress syndrome. , 2013, The New England journal of medicine.

[64]  Arthur S Slutsky,et al.  Acute Respiratory Distress Syndrome The Berlin Definition , 2012 .

[65]  D. Hansell,et al.  Changes in lung composition and regional perfusion and tissue distribution in patients with ARDS , 2011, Respirology.

[66]  L. Blanch,et al.  Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. , 2009, JAMA.

[67]  R. Agarwal,et al.  Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis. , 2008, Chest.

[68]  P. Pelosi,et al.  Pulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality? , 2008, Current opinion in critical care.

[69]  T. Geiser,et al.  The alveolar epithelium can initiate the extrinsic coagulation cascade through expression of tissue factor , 2007, Thorax.

[70]  Laurent Brochard,et al.  Alveolar Recruitment in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome: Comparison Using Pressure-Volume Curve or Static Compliance , 2007, Anesthesiology.

[71]  Guillermo Bugedo,et al.  Lung recruitment in patients with the acute respiratory distress syndrome. , 2006, The New England journal of medicine.

[72]  Arthur S Slutsky,et al.  Pulmonary coagulopathy as a new target in therapeutic studies of acute lung injury or pneumonia—A review , 2006, Critical care medicine.

[73]  P. Pelosi,et al.  Pulmonary and extrapulmonary acute respiratory distress syndrome are different , 2003, European Respiratory Journal.

[74]  F. Taboada,et al.  Expiratory pressure-volume curves in pulmonary and extrapulmonary ARDS , 2002, Critical Care.

[75]  L. Goodman,et al.  What has computed tomography taught us about the acute respiratory distress syndrome? , 2001, American journal of respiratory and critical care medicine.

[76]  P. Pelosi,et al.  Recruitment and derecruitment during acute respiratory failure: a clinical study. , 2001, American journal of respiratory and critical care medicine.

[77]  P. Pelosi,et al.  Recruitment and derecruitment during acute respiratory failure: an experimental study. , 2001, American journal of respiratory and critical care medicine.

[78]  L Puybasset,et al.  Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. , 2001, American journal of respiratory and critical care medicine.

[79]  P. Saldiva,et al.  Morphometric differences in pulmonary lesions in primary and secondary ARDS. A preliminary study in autopsies. , 2001, Pathology, research and practice.

[80]  ntonio,et al.  EFFECT OF PRONE POSITIONING ON THE SURVIVAL OF PATIENTS WITH ACUTE RESPIRATORY FAILURE , 2001 .

[81]  J. Orme,et al.  Endothelial activation in ARDS. , 1999, Chest.

[82]  Arthur S Slutsky,et al.  A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group. , 1998, American journal of respiratory and critical care medicine.

[83]  P. Pelosi,et al.  Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? , 1998, American journal of respiratory and critical care medicine.

[84]  M. Lamy,et al.  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. , 1994, American journal of respiratory and critical care medicine.

[85]  P. Pelosi,et al.  Vertical gradient of regional lung inflation in adult respiratory distress syndrome. , 1994, American journal of respiratory and critical care medicine.

[86]  P. Pelosi,et al.  Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. , 1993, JAMA.

[87]  M. Matthay,et al.  Differential responses of the endothelial and epithelial barriers of the lung in sheep to Escherichia coli endotoxin. , 1991, The Journal of clinical investigation.

[88]  I. Adamson,et al.  Relationship of alveolar epithelial injury and repair to the induction of pulmonary fibrosis. , 1988, The American journal of pathology.

[89]  G. Raghu,et al.  Extracellular matrix in normal and fibrotic human lungs. , 1985, The American review of respiratory disease.

[90]  J. Murray.  Editorial: The adult respiratory distress syndrome (may it rest in peace). , 1975, The American review of respiratory disease.

[91]  T L Petty,et al.  Acute respiratory distress in adults. , 1967, Lancet.