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      a , * , a , a , b , a , b , a , b , a , a , c , c , c , d , 1 , a , b , 1
      Respiratory Physiology & Neurobiology
      Elsevier B.V.
      ARDS, acute respiratory distress syndrome, COVID-19, coronavirus disease 2019, CPAP, continuous positive airway pressure, CT, computed tomography, ECMO, extracorporeal membrane oxygenation, FiO2, fraction of inspired oxygen, HFNO, high flow nasal oxygen, HME, heat-moisture exchanger, HR, hazard ratio, IBW, ideal body weight, ICU, intensive care unit, iNO, inhaled nitric oxide, nCoV, novel coronavirus, NIV, non-invasive ventilation, NMBA, neuromuscular blocking agents, PaO2, partial pressure of oxygen, PBW, predicted body weight, PEEP, positive end-expiratory pressure, Ppl, pleural pressure, RM, recruitment maneuver, RSI, rapid sequence intubation, SaO2, arterial saturation of oxygen, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, SBT, spontaneous breathing trial, SpO2, peripheral saturation of oxygen, SvO2, venous saturation of oxygen, TBW, total body weight, VILI, ventilator-induced lung injury, VT, tidal volume, VV, veno-venous, COVID-19, SARS-CoV-2, mechanical ventilation, prone position, positive end expiratory pressure, non-invasive ventilation

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          Abstract

          Highlights • Chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities, mainly in the subpleural region; 2) inhomogeneously distributed atelectasis and peribronchial opacities; and 3) a patchy, ARDS-like pattern. • Noninvasive positive ventilation and continuous positive airway pressure may result in high inspiratory efforts and high negative intrathoracic pressures and can be detrimental if prolonged. • Endotracheal intubation is considered a high-risk procedure for aerosol-based transmission and should be performed cautiously. • In COVID-19 patients with phenotype 1, respiratory mechanics are consistent with high pulmonary compliance and severe hypoxemia, probably related to regional overperfusion and high shunting (corresponding to the ground-glass opacities). These patients may benefit from use of low to moderate PEEP to redistribute flow from damaged to undamaged areas of the lung and are likely to respond well to inhaled nitric oxide. • In phenotype 2, moderate to high PEEP as well as lateral and/or prone positioning may help recruit collapsed areas. Phenotype 3 resembles typical ARDS and should be managed as such. Finally, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism, regardless of phenotype.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

              Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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                Author and article information

                Contributors
                Journal
                Respir Physiol Neurobiol
                Respir Physiol Neurobiol
                Respiratory Physiology & Neurobiology
                Elsevier B.V.
                1569-9048
                1878-1519
                11 May 2020
                11 May 2020
                : 103455
                Affiliations
                [a ]Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences, Genoa, Italy
                [b ]Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
                [c ]Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
                [d ]Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
                Author notes
                [* ]Corresponding author. kiarobba@ 123456gmail.com
                [1]

                PRM Rocco and P Pelosi share senior authorships

                Article
                S1569-9048(20)30113-0 103455
                10.1016/j.resp.2020.103455
                7211757
                32437877
                cbc612f2-7955-475e-8aaa-2e4c22dcf4e7
                © 2020 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 2 May 2020
                : 4 May 2020
                : 4 May 2020
                Categories
                Article

                Anatomy & Physiology
                ards, acute respiratory distress syndrome,covid-19, coronavirus disease 2019,cpap, continuous positive airway pressure,ct, computed tomography,ecmo, extracorporeal membrane oxygenation,fio2, fraction of inspired oxygen,hfno, high flow nasal oxygen,hme, heat-moisture exchanger,hr, hazard ratio,ibw, ideal body weight,icu, intensive care unit,ino, inhaled nitric oxide,ncov, novel coronavirus,niv, non-invasive ventilation,nmba, neuromuscular blocking agents,pao2, partial pressure of oxygen,pbw, predicted body weight,peep, positive end-expiratory pressure,ppl, pleural pressure,rm, recruitment maneuver,rsi, rapid sequence intubation,sao2, arterial saturation of oxygen,sars-cov-2, severe acute respiratory syndrome coronavirus 2,sbt, spontaneous breathing trial,spo2, peripheral saturation of oxygen,svo2, venous saturation of oxygen,tbw, total body weight,vili, ventilator-induced lung injury,vt, tidal volume,vv, veno-venous,covid-19,sars-cov-2,mechanical ventilation,prone position,positive end expiratory pressure,non-invasive ventilation

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