Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2023; 12(4): 226-235
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.226
Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?
Prithviraj Bose, Binila Chacko, Ashwin Oliver Arul, Leena Robinson Vimala, Balamugesh Thangakunam, George M Varghese, Mohan Jambugulam, Audrin Lenin, John Victor Peter
Prithviraj Bose, Binila Chacko, Ashwin Oliver Arul, John Victor Peter, Department of Medical Intensive Care, Christian Medical College, Vellore 632004, Tamil Nadu, India
Leena Robinson Vimala, Department of Radiodiagnosis, Christian Medical College, Vellore 632004, Tamil Nadu, India
Balamugesh Thangakunam, Department of Pulmonary Medicine, Christian Medical College, Vellore 632004, Tamil Nadu, India
George M Varghese, Department of Infectious Disease, Christian Medical College, Vellore 632004, Tamil Nadu, India
Mohan Jambugulam, Audrin Lenin, Department of Medicine, Christian Medical College, Vellore 632004, Tamil Nadu, India
Author contributions: Bose P, Chacko B, Oliver A, and Peter JV designed and performed the research and wrote the paper, performed literature search, reviewed the final manuscript, and approved for publication; Leena RV, Balamugesh T, George MV, Mohan J, and Audrin L provided clinical advice, literature review, reviewed the final manuscript and approved the manuscript for publication; Peter JV designed the research and supervised the report.
Institutional review board statement: The study was approved by the Institutional Review Board of the institution, (CDSCO- Ethics Committee Registration number: ECR/326/INST/TN/2013/RR-2019; DHR provisional registration number: EC/NEW/INST//2020/818; IRB Min No. 14513, approval date 23.02.2021, study title: “Pulmonary hyperinflammation syndrome in survivors of critically ill COVID-19 Long stayers in ICU – a case series”).
Informed consent statement: In view of the retrospective nature of the study, the large number of COVID-19 patients admitted in the ICU, and deidentification of clinical data, informed consent waiver was obtained from the institutional review board.
Conflict-of-interest statement: There was no conflict of interest or any financial disclosure for all the authors listed in the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: John Victor Peter, DNB, FRACP, MAMS, MD, Professor, Department of Medical Intensive Care, Christian Medical College, Division of Critical Care Christian Medical College Vellore, Vellore 632004, Tamil Nadu, India.
Received: May 11, 2023
Peer-review started: May 11, 2023
First decision: June 15, 2023
Revised: June 24, 2023
Accepted: July 6, 2023
Article in press: July 6, 2023
Published online: September 9, 2023
Core Tip

Core Tip: Delayed respiratory deterioration in critically ill coronavirus disease 2019 (COVID-19) in the absence of new infection, fluid overload, pneumothorax, or lung collapse is seen in a subset of patients admitted to the intensive care unit. This presentation does not fit in to the definition of Multisystem Inflammatory Syndrome Adults, owing to the predominance of pulmonary symptoms and the notable absence of cardiac, gastrointestinal, and mucocutaneous manifestations. In the current study, five patients developed worsening respiratory function requiring escalation of ventilatory support after the third week of COVID-19 illness. This was accompanied by elevated inflammatory markers. All five patients showed clinical response to immunomodulation. This delayed inflammatory pulmonary syndrome contrasts Multisystem Inflammatory Syndrome Adults where extrapulmonary organ involvement predominates.