Inpatient Care during the COVID-19 Pandemic: A Survey of Italian Physicians.
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Anticoagulants
/ therapeutic use
Antiviral Agents
/ therapeutic use
Azithromycin
/ therapeutic use
Betacoronavirus
COVID-19
Cannula
Cardiology
Continuous Positive Airway Pressure
/ methods
Coronavirus Infections
/ complications
Critical Care
Heparin, Low-Molecular-Weight
/ therapeutic use
Hospitalization
Humans
Hydroxychloroquine
/ therapeutic use
Intensive Care Units
Internal Medicine
Italy
Lung
/ diagnostic imaging
Middle Aged
Noninvasive Ventilation
/ methods
Pandemics
Physicians
Pneumonia, Viral
/ complications
Practice Patterns, Physicians'
Protease Inhibitors
/ therapeutic use
Pulmonary Medicine
Referral and Consultation
Respiration, Artificial
/ methods
Respiratory Insufficiency
/ etiology
SARS-CoV-2
Surveys and Questionnaires
Tomography, X-Ray Computed
COVID-19 Drug Treatment
Acute respiratory failure
COVID-19
Mechanical ventilation
Pandemic
Pneumonia
Rehabilitation
Steroid
Journal
Respiration; international review of thoracic diseases
ISSN: 1423-0356
Titre abrégé: Respiration
Pays: Switzerland
ID NLM: 0137356
Informations de publication
Date de publication:
2020
2020
Historique:
received:
14
05
2020
accepted:
27
05
2020
pubmed:
7
8
2020
medline:
2
10
2020
entrez:
7
8
2020
Statut:
ppublish
Résumé
Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern. We explored the clinical management of inpatients with COVID-19 in Italy. 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. 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%. 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.
Sections du résumé
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.
Identifiants
pubmed: 32756065
pii: 000509007
doi: 10.1159/000509007
pmc: PMC7949238
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anticoagulants
0
Antiviral Agents
0
Heparin, Low-Molecular-Weight
0
Protease Inhibitors
0
Hydroxychloroquine
4QWG6N8QKH
Azithromycin
83905-01-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
667-677Informations de copyright
© 2020 S. Karger AG, Basel.
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