case_images: PMC8581035_01
case_images: Disease course and patient management over time in three patients (A-C). ED, Emergency Department; LMWH, low-molecular weight heparin; i.v., intravenous; VM, Venturi mask; FiO2, fractional inspired oxygen; NIV, non-invasive ventilation; CPAP, continuous positive airway pressure; HFNC, high-flow nasal cannulae; FKT, physiokinesitherapy; NC, nasal cannulae; CT, computed tomography; ECMO, extra-corporeal membrane-oxygenation.
case_images: fmed-08-766486-g0001.jpg
case_images: PMC8581035_03_fmed-08-766486-g0001.jpg
case_images: F1
case_images: OTI removal (Figure 1C). On December 22, 2020, a chest CT scan revealed diffuse bilateral GGO and wide consolidating areas with an air bronchogram at the posterior lower lobes. At 6MWT performed on room air, the patient walked 71% of the predicted distance, with a nadir SpO2 of 93% (Figure 1C).
case_images: Computed tomography (CT) axial scans (lung parenchyma windowing) acquired, respectively, immediately before (A), 27 (B) and 111 days (C) after the start of nintedanib, demonstrating progressive improvement of lung parenchyma and significant reduction of residual lung damage. At each time point, the axial CT image most representative of the burden of lung involvement was selected. (D-F) report the corresponding three-dimensional volume rendering images (IntelliSpace Portal v.8.0, Philips Medical Systems, Eindhoven, The Netherlands). The red volume represents the well-aerated parenchyma.
case_images: fmed-08-766486-g0002.jpg
case_images: PMC8581035_01_fmed-08-766486-g0002.jpg
case_images: F2
case_images: On December 4, 2020, a second chest CT scan showed a worsening interstitial thickening, crazy paving areas involving more than 90% of both lungs, and widening of peribronchovascular, mainly subpleural consolidations (Figures 2A,D). A chest CT scan performed at day 27 of therapy showed a dramatic improvement in lung parenchymal alterations (Figures 2B,E), with residual subpleural dense bands mainly involving lower lobes. Chest CT scan performed at this point (day 111 since the start of nintedanib) showed further improvement of lung parenchyma and reduction of residual lung damage (Figures 2C,F).
case_images: The ratio of partial pressure arterial oxygen to fractional inspired oxygen (PaO2/FiO2) and C reactive protein (CRP) levels over time in three patients (A-C). Despite daily variations in minimum and maximum PaO2/FiO2 values, the trend shows progressive respiratory function improvements since the start of nintedanib in all patients.
case_images: fmed-08-766486-g0003.jpg
case_images: PMC8581035_03_fmed-08-766486-g0003.jpg
case_images: F3
case_images: PaO2/FiO2 ratio rapidly improved (Figure 3C), and 6 days after nintedanib introduction, the patient was weaned from the ECMO support. Percutaneous tracheostomy was removed at day 27 of therapy and the patient was transferred to the Rehabilitation Unit.
case_images: PMC8581035_02
case_images: Disease course and patient management over time in three patients (A-C). ED, Emergency Department; LMWH, low-molecular weight heparin; i.v., intravenous; VM, Venturi mask; FiO2, fractional inspired oxygen; NIV, non-invasive ventilation; CPAP, continuous positive airway pressure; HFNC, high-flow nasal cannulae; FKT, physiokinesitherapy; NC, nasal cannulae; CT, computed tomography; ECMO, extra-corporeal membrane-oxygenation.
case_images: fmed-08-766486-g0001.jpg
case_images: PMC8581035_03_fmed-08-766486-g0001.jpg
case_images: F1
case_images: OTI removal (Figure 1C). On December 22, 2020, a chest CT scan revealed diffuse bilateral GGO and wide consolidating areas with an air bronchogram at the posterior lower lobes. At 6MWT performed on room air, the patient walked 71% of the predicted distance, with a nadir SpO2 of 93% (Figure 1C).
case_images: The ratio of partial pressure arterial oxygen to fractional inspired oxygen (PaO2/FiO2) and C reactive protein (CRP) levels over time in three patients (A-C). Despite daily variations in minimum and maximum PaO2/FiO2 values, the trend shows progressive respiratory function improvements since the start of nintedanib in all patients.
case_images: fmed-08-766486-g0003.jpg
case_images: PMC8581035_03_fmed-08-766486-g0003.jpg
case_images: F3
case_images: PaO2/FiO2 ratio rapidly improved (Figure 3C), and 6 days after nintedanib introduction, the patient was weaned from the ECMO support. Percutaneous tracheostomy was removed at day 27 of therapy and the patient was transferred to the Rehabilitation Unit.
case_images: PMC8581035_03
case_images: Disease course and patient management over time in three patients (A-C). ED, Emergency Department; LMWH, low-molecular weight heparin; i.v., intravenous; VM, Venturi mask; FiO2, fractional inspired oxygen; NIV, non-invasive ventilation; CPAP, continuous positive airway pressure; HFNC, high-flow nasal cannulae; FKT, physiokinesitherapy; NC, nasal cannulae; CT, computed tomography; ECMO, extra-corporeal membrane-oxygenation.
case_images: fmed-08-766486-g0001.jpg
case_images: PMC8581035_03_fmed-08-766486-g0001.jpg
case_images: F1
case_images: OTI removal (Figure 1C). On December 22, 2020, a chest CT scan revealed diffuse bilateral GGO and wide consolidating areas with an air bronchogram at the posterior lower lobes. At 6MWT performed on room air, the patient walked 71% of the predicted distance, with a nadir SpO2 of 93% (Figure 1C).
case_images: The ratio of partial pressure arterial oxygen to fractional inspired oxygen (PaO2/FiO2) and C reactive protein (CRP) levels over time in three patients (A-C). Despite daily variations in minimum and maximum PaO2/FiO2 values, the trend shows progressive respiratory function improvements since the start of nintedanib in all patients.
case_images: fmed-08-766486-g0003.jpg
case_images: PMC8581035_03_fmed-08-766486-g0003.jpg
case_images: F3
case_images: PaO2/FiO2 ratio rapidly improved (Figure 3C), and 6 days after nintedanib introduction, the patient was weaned from the ECMO support. Percutaneous tracheostomy was removed at day 27 of therapy and the patient was transferred to the Rehabilitation Unit.