Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers

Abstract

Author Contributions: Drs Selden and Berdahl had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Ultrasound-Guided Minimally Invasive Autopsy of Respiratory Muscles as a Safe and Cost-Effective Technique in COVID-19 Pandemic Era

“…This process leads to atrophy, increasing the extracellular space (edema) that will be occupied by collagen fibers in response to muscle injury, which decreases muscle function. Recently, an autopsy study showed that diaphragm muscle had increased collagen deposit in critically ill patients with COVID-19 infection [ 15 ], which is in accordance with muscle injury, as seen in our study using ultrasound-guided minimally invasive autopsy.…”

Short of Breath for the Long Haul: Diaphragm Muscle Dysfunction in Survivors of Severe COVID-19 as Determined by Neuromuscular Ultrasound

“…Recent autopsy data obtained from COVID-19 patients admitted to an intensive care unit in the Netherlands demonstrated that the angiotensin-converting enzyme 2 (ACE-2) receptor represents an entry point for the severe acute respiratory syndrome coronavirus 2 to directly infect the diaphragm. 8 However, only a modest subset (4 out of 26) had detectable levels of viral ribonucleic acid present in the muscle tissue. Therefore, we hypothesize that the mechanism of diaphragm involvement for the majority of COVID-19 patients is not from direct muscle infection, but more likely analogous to that of critical illness myopathy (CIM).…”

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…Second, long-term impairment of cognitive function may be present in a considerable portion of CARDS survivors [ 172 ]. Third, prolonged neuromuscular dysfunction such as in ICU-acquired weakness (ICU-AW) [ 148 , 149 , 173 ], VIDD [ 150 , 174 ], or dysphagia [ 151 , 152 ] may be present. This may underline the importance of early rehabilitation and mobilization concepts in CARDS (comparable to other critically ill patients) [ 175 , 176 ] with a focus on shortening of the time of mechanical ventilation whenever possible.…”