Diaphragm pathology in critically ill patients with COVID-19 and postmortem findings from 3 medical centers

November 16, 2020

Shi Z, de Vries HJ, Vlaar APJ, et al.

JAMA Internal Medicine

This study investigated the effects of COVID-19 on respiratory muscles, particularly the diaphragm, in critically ill patients. Autopsy diaphragm specimens from 26 patients in the Netherlands that had been critically ill with COVID-19 (COVID-19-ICU) were compared with 8 diaphragm specimens from patients who had been critically ill without COVID-19. Both COVID-19-ICU patients and control patients received invasive mechanical ventilation and stayed in the ICU for comparable amounts of time. Compared to the control samples, diaphragm samples from COVID-19-ICU patients displayed increased expression of fibrosis pathways. Epimysial and perimysial fibrosis were 2-fold greater in COVID-19-ICU diaphragms compared to controls. The authors noted that the causal pathway between SARS-CoV-2 infection and diaphragm myopathy has not yet been established. They hypothesized that fibrosis of the diaphragm that is associated with COVID-19 might lead to ventilator complications, dyspnea, and fatigue in patients after their time in the ICU.

Shi Z, de Vries HJ, Vlaar APJ, et al. Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers. JAMA Intern Med 2020; published online Nov. DOI:10.1001/jamainternmed.2020.6278.

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