COVID-19: general overview, pharmacological options and ventilatory support strategies

  • Francesco Menzella | francesco.menzella@ausl.re.it Department of Medical Specialties, Pneumology Unit, Arcispedale S. Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy. https://orcid.org/0000-0003-3950-5789
  • Andrea Matucci Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
  • Alessandra Vultaggio Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. https://orcid.org/0000-0002-8775-9217
  • Chiara Barbieri Department of Medical Specialties, Pneumology Unit, Arcispedale S. Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy.
  • Mirella Biava University of Rome “La Sapienza”, Rome, Italy.
  • Chiara Scelfo Department of Medical Specialties, Pneumology Unit, Arcispedale S. Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy. https://orcid.org/0000-0002-3192-3882
  • Matteo Fontana Department of Medical Specialties, Pneumology Unit, Arcispedale S. Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy.
  • Nicola Cosimo Facciolongo Department of Medical Specialties, Pneumology Unit, Arcispedale S. Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy.

Abstract

The novel coronavirus called “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) caused an outbreak in December 2019, starting from the Chinese city of Wuhan, in the Hubei province, and rapidly spreading to the rest of the world. Consequently, the World Health Organization (WHO) declared that the coronavirus disease of 2019 (COVID-19) can be characterized as a pandemic. During COVID-19 several immunological alterations have been observed: in plasma of severe patients, inflammatory cytokines are at a much higher concentration (“cytokine storm”). These aspects are associated with pulmonary inflammation and parenchymal infiltrates with an extensive lung tissue damage in COVID-19 patients. To date, clinical evidence and guidelines based on reliable data and randomized clinical trials (RCTs) for the treatment of COVID-19 are lacking. In the absence of definitive management protocols, many treatments are currently being evaluated worldwide. Some of these options were soon abandoned due to ineffectiveness, while others showed promising results. As for ventilatory strategies, at the moment there are still no consistent data published about the different approaches and how they may influence disease progression. What will probably represent the real solution to this pandemic is the identification of a safe and effective vaccine, for which enormous efforts and investments are being put in place. This review will summarize the state-of-the-art of COVID-19 current treatment options and those potentially available in the future, as well as high flow oxygen therapy and non-invasive mechanical ventilation approaches.

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Published
2020-11-09
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Issue
Section
Reviews
Keywords:
Coronavirus, COVID-19, pneumonia, severe acute respiratory syndrome, pharmacologic treatment, respiratory failure, non-invasive ventilation
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How to Cite
Menzella, F., Matucci, A., Vultaggio, A., Barbieri, C., Biava, M., Scelfo, C., Fontana, M., & Facciolongo, N. C. (2020). COVID-19: general overview, pharmacological options and ventilatory support strategies. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.708