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Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

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世界重症医学杂志 2023年第4期12卷 226-235页

作者： Prithviraj Bose Binila Chacko Ashwin Oliver Arul Leena Robinson Vimala balamugesh thangakunam George M Varghese Mohan Jambugulam Audrin Lenin John Victor Peter Department of Medical Intensive Care Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Radiodiagnosis Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Pulmonary Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Infectious Disease Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia

BACKGROUND During the second wave of the coronavirus disease 2019(COVID-19)pandemic,a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extra-pulmonary organ *** To describe the clinical and laboratory characteristics,outcomes,and management of these patients,and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory *** This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital,between May and August 2021,who fulfilled clearly defined inclusion and exclusion *** was assessed by a change in PaO_(2)/FiO_(2) ratio and levels of inflammatory markers before and after immunomodulation,duration of mechanical ventilation after starting treatment,and survival to *** Five patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extrapulmonary organ dysfunction at a median interquartile range(IQR)duration of 32(23-35)d after the onset of *** patients had elevated inflammatory markers,required mechanical ventilation for 13(IQR 10-23)d,and responded to glucocorticoids and/or intravenous *** patient died(20%).CONCLUSION This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome–Adults by the paucity of extrapulmonary organ *** diagnosis can be considered in patients presenting with delayed respiratory worsening,that is not attributable to cardiac dysfunction,fluid overload or ongoing infections,and associated with an increase in systemic inflammatory markers like C-reactive protein,inteleukin-6 and ferritin.A good response to immunomodulation can be *** delayed inflammatory pulmonary syndrome may re

关键词： COVID-19 ARDS Multisystem Inflammatory Syndrome in Adults Long COVID Organizing pneumonia

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