Marina Attanasi1, Simone Pasini2, Antonio Caronni3, Giulia Michela Pellegrino4,5, Paola Faverio6,7, Sabrina Di Pillo1, Matteo Maria Cimino8, Giuseppe Cipolla9, Francesco Chiarelli1, Stefano Centanni4, Giuseppe Francesco Sferrazza Papa10,11. 1. Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, Research Center of Excellence on Aging, University of Chieti, Chieti, Italy. 2. Internal Medicine Unit, Ospedale Maggiore di Lodi, ASST Lodi, UOC Medicina, Lodi, Italy. 3. U.O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, Milan, Italy. 4. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. 5. Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy. 6. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 7. Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy. 8. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Hospital Center - IRCCS, Humanitas University, Rozzano, Italy. 9. ASST Lodi, UOC Pneumologia, Lodi, Italy. 10. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy, giuseppe.sferrazza@unimi.it. 11. Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy, giuseppe.sferrazza@unimi.it.
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.
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.
Authors: Puja Mehta; Daniel F McAuley; Michael Brown; Emilie Sanchez; Rachel S Tattersall; Jessica J Manson Journal: Lancet Date: 2020-03-16 Impact factor: 79.321