What Open‐Lung Biopsy Teaches Us about ARDS in COVID‐19 Patients: Mechanisms, Pathology, and Therapeutic Implications

Abstract

Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients’ specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.

Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19

“… 3 Although inferences can be made from clinical investigations such as peripheral blood sampling, post-mortem tissue analysis provides an unparalleled snapshot of tissue architecture, cellular constituencies, and cell gene-expression profiles, function, and interactions at the time of death. Several alternative approaches to tissue sampling in severe COVID-19 include mini-thoracotomy and transbronchial biopsy; 4 , 5 however, these methods are anatomically limited and not without risk. Analysis of explanted lung tissue from recipients of lung transplants after COVID-19 is hampered by low numbers and the picture is dominated by an advanced fibrotic disease stage.…”

BPC 157 as Potential Treatment for COVID-19

“…In the same vein, BPC 157 has shown to counteract lung lesions in rodent models [89] . This is notable, as these outcomes mimic the outcomes seen with acute respiratory distress syndrome evoked from SARS-CoV-2 [1] , [100] . In rats subjected to monocrotaline-induced pulmonary arterial hypertension BPC 157 applications prevented pulmonary hypertension and advanced pulmonary hypertension was rapidly attenuated and then completely eliminated (Udovocic et.…”

COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review

“…Patients with severe COVID-19 infection display Virchow triad factors of reduced blood flow, microvascular injury, and hypercoagulation 4,7 . These thrombotic risk factors can explain why skin and lung biopsies from critically ill patients reveal microvascular injury 9,10 . Moreover, they provide a potential explanation for the relationship between COVID-19 and HAPIs because localized ischemia is considered a primary driver of pressure injuries 8,11 .…”