• Marina Attanasi, Simone Pasini, Antonio Caronni, Giulia Michela Pellegrino, Paola Faverio, Sabrina Di Pillo, Matteo Maria Cimino, Giuseppe Cipolla, Francesco Chiarelli, Stefano Centanni, Giuseppe Francesco Sferrazza Papa, and Collaborators for the RECOVER Investigators Study Group.
• Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, Research Center of Excellence on Aging, University of Chieti, Chieti, Italy.
• Respiration. 2020 Jan 1; 99 (8): 667-677.

BackgroundCoronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern.ObjectiveWe explored the clinical management of inpatients with COVID-19 in Italy.MethodsA self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed.ResultsA total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%.ConclusionsIn our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.© 2020 S. Karger AG, Basel.

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