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Multidisciplinary Approach to Severe COVID Infection
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Multidisciplinary Approach to Severe COVID Infection

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (21 October 2023) | Viewed by 7487

Special Issue Editors

Dr. Claudio Rabec

E-Mail Website
Guest Editor
Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
Interests: non-invasive ventilation; mechanical ventilation; COVID-19; acute respiratory failure; ARDS; viral pandemic; nasal high flow therapy; rehabilitation
Dr. Marjolaine Georges

E-Mail Website
Guest Editor
Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
Interests: non-invasive ventilation; mechanical ventilation; COVID-19; acute respiratory failure; ARDS; viral pandemic; nasal high flow therapy; rehabilitation

Special Issue Information

Dear Colleagues,

SARS-CoV-2 has been identified as the agent of the pandemic known as COVID-19. With the first cases noted towards the end of 2019 in China, COVID-19 infection has caused morbidity and mortality at an unprecedented scale and became a devastating worldwide pandemic. Compared to other coronaviruses that have caused epidemics over the last 2 decades, including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 exhibits a higher infectivity and has spread throughout the world in a short period. At the time of writing, more than 545 million of cases have been reported worldwide, with a mortality approaching 6.5 million.  The hallmark of the disease is pulmonary injury. Extra-pulmonary symptoms are less frequent, even sometimes severe. Neurological, cardiac, renal, gastrointestinal, ocular, vascular and olfactory abnormalities were also reported. Multi-organ manifestations may be correlated due to the abundancy of the ACE2 receptors in various organs.

The clinical presentation can vary from mild respiratory symptoms to severe pneumonia progressing to fulminant acute respiratory failure (ARF). The estimated prevalence of COVID-19-related acute respiratory failure (ARF) is 15–20%. In different published series, 41% of patients received O2, 4–13% non-invasive ventilation, and 2–12% needed intubation and mechanical ventilation. COVID-19 pneumonia is characterized by bilateral infiltrates, which can progress to diffuse alveolar condensations. In less severely ill patients, computed tomography (CT) shows bilateral ground glass sub pleural opacities. Finally, and most importantly, respiratory sequelae are frequent, including pulmonary fibrosis, which may reach 19% of hospitalized patients with COVID-19 and 39% in the subgroup of ARDS patients.

A hallmark of the COVID-19 pandemic is the sudden appearance of an unprecedented number of critically ill patients. This overwhelmed local health care resources, resulting in shortages of trained staff, ventilators, renal-replacement therapy, and intensive care unit beds.

This new disease and its tragic consequences have led the medical world to innovate and gradually but rapidly improve the specialized respiratory care of these patients.

The aim of this Special Issue is to present current concepts and developing trends in COVID-19 infection using a multidisciplinary approach. The opinions and experience of specialists from different fields implicated in the management of this pandemic were collated. The goal is to paint a picture of the impact of COVID-19 on different organs and its clinical implications for the management of this disease. Authors will provide information about epidemiological, pathophysiological, clinical, therapeutic and ethical aspects of this emerging condition.

Dr. Claudio Rabec
Dr. Marjolaine Georges
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19 infection
  • non-invasive ventilation
  • acute respiratory failure
  • mechanical ventilation
  • multidisciplinary approach

Published Papers (5 papers)

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Review

14 pages, 1062 KiB  
Review
Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2
by Gauthier Duloquin, Thibaut Pommier, Marjolaine Georges, Maurice Giroud, Charles Guenancia, Yannick Béjot, Gabriel Laurent and Claudio Rabec
J. Clin. Med. 2024, 13(5), 1397; https://doi.org/10.3390/jcm13051397 - 28 Feb 2024
Cited by 1 | Viewed by 1386
Abstract
First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can [...] Read more.
First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation. Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Severe COVID Infection)
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12 pages, 479 KiB  
Review
Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2
by Marine Jacquier, Marie Labruyère, Fiona Ecarnot, Jean-Baptiste Roudaut, Pascal Andreu, Pierre Voizeux, Quentin Save, Romain Pedri, Jean-Philippe Rigaud and Jean-Pierre Quenot
J. Clin. Med. 2023, 12(24), 7509; https://doi.org/10.3390/jcm12247509 - 5 Dec 2023
Viewed by 1108
Abstract
The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen [...] Read more.
The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance. Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Severe COVID Infection)
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13 pages, 1214 KiB  
Review
COVID-19 and the Concept of Thrombo-Inflammation: Review of the Relationship between Immune Response, Endothelium and Coagulation
by Emmanuel de Maistre, Philippe Savard and Pierre-Gregoire Guinot
J. Clin. Med. 2023, 12(23), 7245; https://doi.org/10.3390/jcm12237245 - 23 Nov 2023
Cited by 3 | Viewed by 1296
Abstract
COVID-19, caused by the SARS-CoV-2 virus, has revealed a complex interplay between inflammation and coagulation, leading to the emergence of the concept of thrombo-inflammation. This concept recognizes that COVID-19 is not solely a respiratory illness, but a systemic disease with significant vascular and [...] Read more.
COVID-19, caused by the SARS-CoV-2 virus, has revealed a complex interplay between inflammation and coagulation, leading to the emergence of the concept of thrombo-inflammation. This concept recognizes that COVID-19 is not solely a respiratory illness, but a systemic disease with significant vascular and hematological components. COVID-19 is associated with an unusual prothrombotic state, with intense endothelial activation leading to vasculopathy, cytokine storm, complement system activation and a hypercoagulability state (the activation of platelets and the coagulation cascade, impaired fibrinolysis). The aim of this review is to discuss the different pathological pathways described in COVID-19 that lead to thromboembolic events. Widespread vaccination and post-COVID-19 immunization allows control over the severity of this pandemic. A better understanding of the pathophysiology of COVID-19 can improve the management of frail patients who are hospitalized in intensive care units. Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Severe COVID Infection)
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14 pages, 297 KiB  
Review
Non-Pharmacological Strategies and Interventions for Effective COVID-19 Control: A Narrative Review
by Ludwig Serge Aho Glele and Alexis de Rougemont
J. Clin. Med. 2023, 12(20), 6465; https://doi.org/10.3390/jcm12206465 - 11 Oct 2023
Cited by 2 | Viewed by 1857
Abstract
The COVID-19 pandemic had a devastating impact on the world, causing widespread illness and death. Focusing on prevention strategies to limit the spread of the disease remains essential. Despite the advent of vaccines, maintaining a vigilant approach to prevention remains paramount. We reviewed [...] Read more.
The COVID-19 pandemic had a devastating impact on the world, causing widespread illness and death. Focusing on prevention strategies to limit the spread of the disease remains essential. Despite the advent of vaccines, maintaining a vigilant approach to prevention remains paramount. We reviewed effective strategies to prevent COVID-19 transmission, including various prevention measures and interventions and both established practices and unresolved issues that have been addressed in meta-analyses, literature reviews, or in the health care context. Standard precautions are the cornerstone of infection control, with hand hygiene and mask use as key components. The use of surgical masks is recommended to prevent droplet transmission, while eye protection is recommended in combination with masks. In terms of room occupancy, ventilation is critical in reducing the risk of transmission in poorly ventilated environments. Chemical disinfection of indoor air with Triethylene glycol-based products can provide safe additional protection. Since viral RNA detection on surfaces does not necessarily indicate infectivity, the risk of transmission by surface contact remains low if surfaces are properly maintained and hand hygiene is practiced regularly. Thus, prevention of SARS-CoV-2 transmission requires a multifaceted approach, including reducing particle emissions from infected persons by wearing masks, eliminating aerosols by ventilation and air treatment, ensuring physical separation, and protecting exposed persons with masks and eye protection. Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Severe COVID Infection)
16 pages, 682 KiB  
Review
Healing Treatments in COVID-19 Patients: A Narrative Review
by Thibault Sixt, Florian Moretto, Clementine Esteve, Michel Duong, Marielle Buisson, Sophie Mahy, Mathieu Blot and Lionel Piroth
J. Clin. Med. 2023, 12(14), 4672; https://doi.org/10.3390/jcm12144672 - 14 Jul 2023
Cited by 2 | Viewed by 1294
Abstract
Since December 2019, many drugs have been evaluated or advocated as potential treatments of SARS-CoV-2 induced disease (COVID-19), including many repositioned drugs and some others specifically developed for these diseases. They can be roughly classified into three categories according to their main mechanism [...] Read more.
Since December 2019, many drugs have been evaluated or advocated as potential treatments of SARS-CoV-2 induced disease (COVID-19), including many repositioned drugs and some others specifically developed for these diseases. They can be roughly classified into three categories according to their main mechanism of action (passive immunization, direct antivirals, and anti-inflammatory treatments), and their use depends on the stage of the disease. Despite often promising preclinical data, most of the treatments evaluated failed to show a significant clinical benefit. In addition, a few others have seen their effectiveness affected by the occurrence of SARS-CoV-2 variants and sub-variants. Herein, the aim of this article is to take stock of the data available as of the 14th of July 2022, concerning the specific healing options evaluated for patients suffering from COVID-19. We focus particularly on healing treatments of COVID-19 and do not deal with preventive treatments such as vaccine. Associated therapies such as venous thromboembolism prophylaxis are not detailed since they are covered in a specific chapter of this issue. Passive immunization, especially through monoclonal antibodies, showed a positive impact on the clinical evolution, whether in outpatients or inpatients without oxygen supply. However, their effectiveness strongly depends on the type of SARS-CoV-2 variant, and often decreases or even vanishes with the most recent variants. Among direct antiviral treatments, ritonavir-boosted nirmatrelvir appears to currently be the cornerstone in the management of early infections, but its use may be limited by drug interactions. Remdesivir remains as an alternative in this situation, even though it is potentially less convenient. Anti-inflammatory treatments have often been shown to be the most effective in inpatients with oxygen supply. Dexamethasone is now a cornerstone of management of these patients. Added tocilizumab seems beneficial in the case of hyper inflammation. JAK inhibitors and anakinra have also gained an interest in some studies. As a conclusion of this narrative review, the best treatment strategy has yet to be defined and is likely to evolve in the future, not only because many other drugs are still under development and evaluation, but also because of the viral epidemics and epidemiology evolution. Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Severe COVID Infection)
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