Skip to main content

Clinical Presentation and Phenotypes in COVID-19

  • Chapter
  • First Online:
  • 435 Accesses

Abstract

Since the beginning of the COVID-19 pandemic, researchers have focused on the different clinical presentations of the disease. The existence of a broad spectrum of respiratory compromise has been initially interpreted as the manifestation of different clinical phenotypes, with peculiar pathophysiological aspects translating into different requirements of respiratory support. Extensive research now converges on interpreting these phenotypes as different stages rather than distinct manifestations of the same pathology. While not all patients will evolve from an early COVID-19 pneumonia to an established COVID-19 related acute respiratory distress syndrome (ARDS), the correct identification of the disease phase will translate into different therapeutic approaches. This chapter discusses the classification of COVID-19 phenotypes based on imaging and respiratory mechanics parameters, also in relation with the differences and similarities with the ARDS from causes other than COVID-19.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102. https://doi.org/10.1007/s00134-020-06033-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Robba C, Battaglini D, Ball L, Patroniti N, Loconte M, Brunetti I, Vena A, Giacobbe DR, Bassetti M, Rocco PRM, et al. Distinct phenotypes require distinct respiratory management strategies in severe COVID-19. Respir Physiol Neurobiol. 2020;279:103455.

    Article  CAS  Google Scholar 

  3. Gandhi RT, Lynch JB, del Rio C. Mild or moderate Covid-19. N Engl J Med. 2020;383:1757–66.

    Article  CAS  Google Scholar 

  4. Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020;383:2451–60.

    Article  CAS  Google Scholar 

  5. Tonelli R, Marchioni A, Tabbì L, Fantini R, Busani S, Castaniere I, Andrisani D, Gozzi F, Bruzzi G, Manicardi L, et al. Spontaneous breathing and evolving phenotypes of lung damage in patients with COVID-19: review of current evidence and forecast of a new scenario. J Clin Med. 2021;10:975.

    Article  CAS  Google Scholar 

  6. Inui S, Fujikawa A, Jitsu M, Kunishima N, Watanabe S, Suzuki Y, Umeda S, Uwabe Y. Chest CT findings in cases from the cruise ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19). Radiol Cardiothorac Imaging. 2020;2:e200110.

    Article  Google Scholar 

  7. Ball L, Robba C, Maiello L, Herrmann J, Gerard SE, Xin Y, Battaglini D, Brunetti I, Minetti G, Seitun S, et al. Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia. Crit Care. 2021;25:81.

    Article  Google Scholar 

  8. Vaporidi K, Akoumianaki E, Telias I, Goligher EC, Brochard L, Georgopoulos D. Respiratory drive in critically ill patients. Pathophysiology and clinical implications. Am J Respir Crit Care Med. 2020;201:20–32.

    Article  Google Scholar 

  9. Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of “happy” hypoxemia in COVID-19. Respir Res. 2020;21:198.

    Article  CAS  Google Scholar 

  10. Mauri T, Spinelli E, Scotti E, Colussi G, Basile MC, Crotti S, Tubiolo D, Tagliabue P, Zanella A, Grasselli G, et al. Potential for lung recruitment and ventilation–perfusion mismatch in patients with the acute respiratory distress syndrome from Coronavirus Disease 2019. Crit Care Med. 2020;48(8):1129. https://doi.org/10.1097/CCM.0000000000004386.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ball L, Robba C, Herrmann J, Gerard SE, Xin Y, Mandelli M, Battaglini D, Brunetti I, Minetti G, Seitun S, et al. Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study. Crit Care. 2021;25:214.

    Article  Google Scholar 

  12. Tonelli R, Busani S, Tabbì L, Fantini R, Castaniere I, Biagioni E, Mussini C, Girardis M, Clini E, Marchioni A. Inspiratory effort and lung mechanics in spontaneously breathing patients with acute respiratory failure due to COVID-19: a matched control study. Am J Respir Crit Care Med. 2021;204:725–8.

    Article  Google Scholar 

  13. Agarwal A, Basmaji J, Muttalib F, Granton D, Chaudhuri D, Chetan D, Hu M, Fernando SM, Honarmand K, Bakaa L, et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth. 2020;67:1217–48.

    Article  CAS  Google Scholar 

  14. Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10:78.

    Article  Google Scholar 

  15. Battaglini D, Robba C, Ball L, Silva PL, Cruz FF, Pelosi P, Rocco PRM. Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. Br J Anaesth. 2021;127:353–64.

    Article  CAS  Google Scholar 

  16. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189:520–31.

    Article  Google Scholar 

  17. Botta M, Tsonas AM, Pillay J, Boers LS, Algera AG, Bos LDJ, Dongelmans DA, Hollmann MW, Horn J, Vlaar APJ, et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med. 2021;9:139–48.

    Article  CAS  Google Scholar 

  18. Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G, Laffey J, Carrafiello G, Carsana L, Rizzuto C, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med. 2020;8(12):1201–8. https://doi.org/10.1016/S2213-2600(20)30370-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Chiumello D, Busana M, Coppola S, Romitti F, Formenti P, Bonifazi M, Pozzi T, Palumbo MM, Cressoni M, Herrmann P, et al. Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. Intensive Care Med. 2020;46(12):2187–96. https://doi.org/10.1007/s00134-020-06281-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Protti A, Santini A, Pennati F, Chiurazzi C, Cressoni M, Ferrari M, Iapichino GE, Carenzo L, Lanza E, Picardo G, et al. Lung response to a higher positive end-expiratory pressure in mechanically ventilated patients with COVID-19. Chest. 2021;161(4):979–88. https://doi.org/10.1016/j.chest.2021.10.012.

    Article  CAS  PubMed  Google Scholar 

  21. Lavinio A, Ercole A, Battaglini D, Magnoni S, Badenes R, Taccone FS, Helbok R, Thomas W, Pelosi P, Robba C, et al. Safety profile of enhanced thromboprophylaxis strategies for critically ill COVID-19 patients during the first wave of the pandemic: observational report from 28 European intensive care units. Crit Care. 2021;25:155.

    Article  Google Scholar 

  22. Ball L, Barisione E, Mastracci L, Campora M, Costa D, Robba C, Battaglini D, Micali M, Costantino F, Cittadini G, et al. Extension of collagen deposition in COVID-19 post mortem lung samples and computed tomography analysis findings. Int J Mol Sci. 2021;22:7498.

    Article  CAS  Google Scholar 

Download references

Financial Support and Sponsorship

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lorenzo Ball .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Boccafogli, R., Robba, C., Ball, L. (2022). Clinical Presentation and Phenotypes in COVID-19. In: Battaglini, D., Pelosi, P. (eds) COVID-19 Critical and Intensive Care Medicine Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-94992-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94992-1_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94991-4

  • Online ISBN: 978-3-030-94992-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics