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.

Inpatient Care during the COVID-19 Pandemic : A Survey of Italian Physicians / M. Attanasi, S. Pasini, A. Caronni, G.M. Pellegrino, P. Faverio, S. Di Pillo, M.M. Cimino, G. Cipolla, F. Chiarelli, S. Centanni, G.F. Sferrazza Papa. - In: RESPIRATION. - ISSN 0025-7931. - 99:8(2020 Aug), pp. 667-677. [10.1159/000509007]

Inpatient Care during the COVID-19 Pandemic : A Survey of Italian Physicians

S. Pasini;A. Caronni;G.M. Pellegrino;M.M. Cimino;S. Centanni;G.F. Sferrazza Papa
Ultimo
2020-08

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.
Acute respiratory failure; COVID-19; Mechanical ventilation; Pandemic; Pandemic; Pneumonia; Rehabilitation; Steroid; Adult; Aged; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Azithromycin; Betacoronavirus; Cannula; Cardiology; Continuous Positive Airway Pressure; Coronavirus Infections; Critical Care; Heparin, Low-Molecular-Weight; Humans; Hydroxychloroquine; Intensive Care Units; Internal Medicine; Italy; Lung; Middle Aged; Noninvasive Ventilation; Pandemics; Physicians; Pneumonia, Viral; Protease Inhibitors; Pulmonary Medicine; Referral and Consultation; Respiration, Artificial; Respiratory Insufficiency; Surveys and Questionnaires; Tomography, X-Ray Computed; Hospitalization; Practice Patterns, Physicians'
Settore MED/10 - Malattie dell'Apparato Respiratorio
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/777528
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