Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study
Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilat...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2024-04-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/macd/article/view/2829 |
| _version_ | 1797193500519825408 |
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| author | Luigi Vetrugno Cristian Deana Savino Spadaro Gianmaria Cammarota Domenico Luca Grieco Annarita Tullio Tiziana Bove Carla Di Loreto Salvatore Maurizio Maggiore Maria Orsaria DIASUS study group |
| author_facet | Luigi Vetrugno Cristian Deana Savino Spadaro Gianmaria Cammarota Domenico Luca Grieco Annarita Tullio Tiziana Bove Carla Di Loreto Salvatore Maurizio Maggiore Maria Orsaria DIASUS study group |
| author_sort | Luigi Vetrugno |
| collection | DOAJ |
| description |
Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers’ atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.
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| first_indexed | 2024-04-24T05:41:23Z |
| format | Article |
| id | doaj.art-42f760aa36d64edc8066666e7b285e4d |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-04-24T05:41:23Z |
| publishDate | 2024-04-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-42f760aa36d64edc8066666e7b285e4d2024-04-23T20:25:06ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642024-04-0110.4081/monaldi.2024.2829Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational studyLuigi Vetrugno0Cristian Deana1Savino Spadaro2Gianmaria Cammarota3Domenico Luca Grieco4Annarita Tullio5Tiziana Bove6Carla Di Loreto7Salvatore Maurizio Maggiore8Maria Orsaria9DIASUS study groupDepartment of Medical, Oral and Biotechnological Sciences, Gabriele d’Annunzio University of Chieti Pescara, Chieti; Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, ChietiDepartment of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of UdineDepartment of Translational Medicine, University of Ferrara; Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, FerraraDepartment of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara; Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, NovaraDepartment of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, RomeHealth Integrated Agency Friuli Centrale, Academic Hospital of UdineDepartment of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine; Department of Medicine, University of UdineDepartment of Medicine, University of Udine; Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of UdineDepartment of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, ChietiInstitute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers’ atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers. https://www.monaldi-archives.org/macd/article/view/2829COVID-19invasive mechanical ventilationdiaphragm dysfunctionmyosinventilation-induce diaphragm injury |
| spellingShingle | Luigi Vetrugno Cristian Deana Savino Spadaro Gianmaria Cammarota Domenico Luca Grieco Annarita Tullio Tiziana Bove Carla Di Loreto Salvatore Maurizio Maggiore Maria Orsaria DIASUS study group Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study Monaldi Archives for Chest Disease COVID-19 invasive mechanical ventilation diaphragm dysfunction myosin ventilation-induce diaphragm injury |
| title | Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study |
| title_full | Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study |
| title_fullStr | Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study |
| title_full_unstemmed | Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study |
| title_short | Diaphragmatic morphological <i>post-mortem</i> findings in critically ill COVID-19 patients: an observational study |
| title_sort | diaphragmatic morphological i post mortem i findings in critically ill covid 19 patients an observational study |
| topic | COVID-19 invasive mechanical ventilation diaphragm dysfunction myosin ventilation-induce diaphragm injury |
| url | https://www.monaldi-archives.org/macd/article/view/2829 |
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