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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">While most patients only develop a common mild form of COVID-19&#44; approximately 15&#37; of the patients require assisted oxygenation or mechanical ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">1</span></a> In the lungs&#44; SARS-CoV-2 enters the cells <span class="elsevierStyleItalic">via</span> the angiotensin-converting enzyme 2 &#40;ACE2&#41; expressed in lung alveolar cells &#40;type I and II alveolar epithelial cells&#41;&#44; bronchial epithelium and vascular endothelial cells&#59; thus explaining why respiratory tract and lung serve as a primary point of viral entry&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">2&#8211;4</span></a> COVID-19 respiratory phenotypes seem to be slightly different from &#8220;typical&#8221; acute respiratory distress syndrome &#40;ARDS&#41; phenotypes&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5&#8211;7</span></a> Thus&#44; pulmonary radiology studies in COVID-19 showed lesions more similar to organizing pneumonia&#44; especially in the early stages of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8&#44;9</span></a> Although several studies have now described clinical&#44; radiographic and pathologic features of COVID-19&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">10&#44;11</span></a> no studies have been conducted on the basis of early biopsies in the deceased&#46; Some of the reasons for the lack of biopsies include suddenness of the outbreak&#44; massive influx of patients in hospitals&#44; shortage of medical staff&#44; and high rate of transmission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The present study has been designed to assess the chronology of histologic features of SARS-CoV-2-induced pulmonary disease&#44; by analyzing immediate postmortem transthoracic biopsies performed in patients hospitalized in intensive care unit for severe forms of COVID-19&#46; Indeed&#44; in a recent report&#44; Sapino et al&#46; suggested that tissue sampling using biopsies may be an interesting and safer alternative to autopsy for research projects during outbreaks such as COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">Between March 25&#44; 2020 and May 2&#44; 2020&#44; all patients who died from ARDS related to COVID-19 were prospectively included in four intensive care units &#40;ICUs&#41; in two centers of a French tertiary hospital in Strasbourg&#46; 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the histological hallmark for ARDS&#46; Capillary congestion&#44; intra-alveolar edema&#44; loose fibrin deposition and hyaline membranes were considered as exudative changes&#46; Type II pneumocyte hyperplasia&#44; alveolar septa thickening with fibroblast proliferation and organizing fibroblastic tissue in air spaces were considered as features of the proliferative&#47;organizing phase&#46; Prominent interstitial collagenous fibrosis with architectural remodeling and&#47;or honeycomb-like change defined the fibrotic phase&#46; Extensive intra-alveolar fibrin deposition forming fibrin &#8220;balls&#8221; in alveolar ducts and alveoli&#44; coexisting with intraluminal loose connective tissue polyps were histologic criteria of acute fibrinous and organizing pneumonia &#40;AFOP&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Interstitial and intra-alveolar inflammatory infiltrate was analyzed using an automated chromogenic multiplexed immunohistochemistry assay on the Discovery Ultra automated immunostainer &#40;Ventana Medical Systems&#44; Tucson&#44; AZ&#44; USA&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">14</span></a> with four antibodies targeting CD4&#44; CD8&#44; CD20 and CD68&#46; Presence of SARS-CoV-2 virus in the lung tissue sections was evaluated by <span class="elsevierStyleItalic">in situ</span> hybridization &#40;ISH&#41; using RNAscope technology with a SARS-Cov-2 spike probe to COVID-19 coronavirus<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">15</span></a> and by immunohistochemistry with a polyclonal Sars nucleocapsid protein antibody &#40;200-401-A50&#59; Rockland Immunochemicals&#44; Inc&#46;&#44; USA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of this study is descriptive&#46; No formal hypothesis was implemented to drive the sample size calculation and the maximum number of patients who met the inclusion criteria was included&#46; Descriptive data were expressed as mean &#40;SD&#41; or median &#40;IQR&#41; for continuous variables and categorical variables as number &#40;&#37;&#41;&#46; Tests were two-sided with significance set at <span class="elsevierStyleItalic">&#945;</span> less than 0&#46;05&#46; Differences between groups were considered to be significant at a <span class="elsevierStyleItalic">P</span> value of<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Students&#8217; <span class="elsevierStyleItalic">t</span>-test was performed to compare two groups sampled from normal distributions with equal variances&#46; One-way analysis of variance &#40;one-way ANOVA&#41; was used to compare means of more than two groups&#46; Statistical analyses were performed with GraphPad Prism 8 &#40;GraphPad Software&#44; Inc&#46;&#44; San Diego&#44; CA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Baseline characteristics of the patients</span><p id="par0045" class="elsevierStylePara elsevierViewall">A Total of 183 patients were admitted in ICU during this period&#46; Twenty-two patients were included in this study&#46; Median age was 66 &#91;63&#8211;74&#93; years&#46; 16&#47;22 &#40;73&#37;&#41; patients were male&#46; Predominant medical history of these patients was overweight and obesity&#46; Few patients were active smokers&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> provides an overview of initial laboratory results&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> provides an overview of ventilatory parameters at admission and at time of death&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Clinical description of the patients</span><p id="par0050" class="elsevierStylePara elsevierViewall">Median SAPS II and SOFA scores on admission in ICU were respectively 58 &#91;47&#8211;67&#93; and 11 &#91;8&#8211;15&#93;&#46; The median duration of mechanical ventilation was 17 &#91;8&#8211;24&#93; days&#46; 20&#47;22 patients &#40;91&#37;&#41; received neuromuscular blocking drugs &#40;NMBD&#41; with a median of 8 &#91;6&#8211;15&#93; days&#46; 11&#47;22 patients &#40;50&#37;&#41; received inhaled nitric oxide&#46; 13&#47;22 patients &#40;59&#37;&#41; developed ventilator-associated pneumonia &#40;VAP&#41;&#46; 11&#47;22 &#40;50&#37;&#41; patients received corticosteroids for a median of 9 &#91;7&#8211;10&#93; days&#46; Median dynamic respiratory system compliance at death was 21 &#91;15&#8211;24&#93;<span class="elsevierStyleHsp" style=""></span>mL&#47;cmH<span class="elsevierStyleInf">2</span>O&#46; 5&#47;22 patients &#40;23&#37;&#41; received veno-venous extracorporeal membrane oxygenation &#40;VV-ECMO&#41;&#46; 8&#47;22 patients &#40;36&#37;&#41; developed a pulmonary embolism&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were stratified according to the delay since the beginning of clinical criteria for ARDS related to COVID-19&#58; 4 &#40;18&#37;&#41; patients with severe pneumonia for less than 1 week&#44; 11 &#40;50&#37;&#41; patients between 1 and 3 weeks&#44; and 7 &#40;32&#37;&#41; patients for more than 3 weeks&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the four patients who died during the first week&#44; one died of cardiac arrest induced by tension pneumothorax and three had limit in therapeutic effort &#40;one because of Ewing Sarcoma and multiple myeloma&#44; one because of acute promyelocytic leukemia with stroke and one because of multiple organ failure due to COVID-19 and a <span class="elsevierStyleItalic">staphylococcus aureus</span> VAP&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Histologic patterns</span><p id="par0065" class="elsevierStylePara elsevierViewall">The average number of lung tissue probes obtained by needle biopsies from different lobes was 9&#46;4&#46; As expected&#44; histologic features of exudative&#44; proliferative and fibrotic phase of DAD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows different histological findings&#41; were observed&#46; Time to onset of histological lesions was closely related to the duration of evolution of ARDS related to COVID-19 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Exudative changes were present in 3 of the 4 patients &#40;75&#37;&#41; within the first week of ARDS related to COVID-19&#44; 8 of the 11 patients &#40;72&#37;&#41; within the second and third weeks&#44; and none of the 7 patients with more than 3 weeks of evolution &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Intra-alveolar loose fibrin exudate and hyaline membranes gradually decreased over weeks &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01 respectively&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">By contrast&#44; the incidence of proliferative changes increased over time and were reported in 2&#47;4 patients &#40;50&#37;&#41; within the first week&#44; 8&#47;11 patients &#40;73&#37;&#41; within the 1&#8211;3 weeks&#44; and 6&#47;7 patients &#40;88&#37;&#41; after the third week &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Hyperplasia of type II pneumocytes mostly with cytologic atypia was noted in 17 of the 19 patients &#40;89&#37;&#41; presenting proliferative changes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of end-stage fibrosis increased over time&#58; the pattern appeared in none of the 4 patients with disease for less than 1 week&#44; in 3 of the 11 patients &#40;27&#37;&#41; with disease for 1&#8211;3 weeks&#44; and in all &#40;100&#37;&#41; of the patients with a disease of more than 3 weeks &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Patients with end-stage fibrosis had been on mechanical ventilation for a longer period of time than patients without fibrosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; It should be noted that histological criteria of more than one phase coexisted in 16 of 22 patients &#40;73&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">No differences in histologic findings were observed between patients who received steroids and those who did not &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Regarding patients who developed a VAP and those who did not&#44; there was significantly more fibrosis in the patients who developed VAP &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Features of AFOP were found in 10 patients &#40;45&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; They began to appear during the second&#8211;third week in 36&#37; of the patients&#44; with a large number of fibrin balls&#59; and were found in 86&#37; of the patients after the third week &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; showing remnants of fibrin plugs associated with loose fibrous polyps of organizing pneumonia &#40;OP&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Immune cell population</span><p id="par0090" class="elsevierStylePara elsevierViewall">Interstitial inflammatory infiltrate was found in all patients regardless of the duration of ventilation&#46; It was mostly mild to moderate&#44; and composed of lymphocytes with some monocytes&#46; Plasma cells were present after the third week&#46; Neutrophils were scarce&#46; Endo-alveolar infiltrate was present in 19&#47;22 &#40;86&#37;&#41; of patients and almost exclusively composed by macrophages&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Immune cell subpopulations were analyzed in 12&#47;22 cases &#40;from day 1 to day 25 after ventilation&#41; using an automated chromogenic multiplexed immunohistochemistry &#40;IHC&#41; assay with four antibodies &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In all cases only rare scattered interstitial CD20&#43; B-cells were observed&#46; The infiltrate consisted of T-cells&#44; with a mixture of CD4&#43; and CD8&#43; lymphocytes&#46; There were slightly more CD4&#43; than CD8&#43; lymphocytes in 6&#47;12 &#40;50&#37;&#41;&#44; and slightly more CD8&#43; than CD4&#43; lymphocytes in 6&#47;12 &#40;50&#37;&#41; of patients&#46; CD68&#43; macrophages were mostly located in alveolar spaces&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Viral status in lung tissue</span><p id="par0100" class="elsevierStylePara elsevierViewall">The presence of the SARS-CoV2&#8212;tested by immunohistochemistry &#40;IHC&#41;&#8212;was only found in 2&#47;22 patients &#40;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Both died early&#44; during the first week of ICU stay&#44; after 4 and 7 days of symptomatic illness&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As IHC&#44; RNA scope allowed detection of SARS-CoV-2 viral RNA only in the two same patients &#40;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Both viral RNA and protein were located in atypical pneumocytes and in some intra-alveolar macrophages&#46; No staining of endothelial cells could be identified&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although RT-PCR testing for the virus in tracheobronchial secretions was positive up until death in the majority of our patients &#40;20&#47;22 patients&#41;&#8212;using the two methods &#40;IHC and RNAscope&#41;&#8212;no trace of the virus was found in lung tissue of patients who died after the first week&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Endothelial and microcirculation injury</span><p id="par0120" class="elsevierStylePara elsevierViewall">Even if 8&#47;22 patients &#40;36&#37;&#41; developed a pulmonary embolism&#44; only two of the 22 patients had recent thrombosis of small pulmonary arteries and one patient had endotheliitis in lung vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; To note&#44; all patients received heparin therapy&#46; Six received prophylactic anticoagulation &#40;27&#46;3&#37;&#41; and 16 therapeutic anticoagulation &#40;72&#46;7&#37;&#41;&#46; Other common findings were diffuse small vessel platelet aggregation&#44; intra-alveolar hemorrhage or areas of hemorrhagic necrosis of the lung parenchyma&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Herein&#44; we report the histopathological features of SARS-CoV-2-induced pulmonary disease&#46; Although this ARDS is typical in term of histological injuries and chronology&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">18</span></a> it is characterized by predominant acute fibrinous and organizing pneumonia &#40;AFOP&#41; and potential more pro-fibrotic evolution&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As described by Katzenstein et al&#46; in 1976&#44; the histological hallmark of ARDS is diffuse alveolar damage &#40;DAD&#41;&#44; consisting of changes such as hyaline membranes&#44; interstitial edema&#44; cell necrosis and proliferation&#44; or&#47;and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a> In our series&#44; such changes were present&#44; but the predominant feature was loose fibrin deposition and&#47;or fibrin balls within the alveolar spaces&#44; that evolved towards organizing pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a> which is uncommon in classic DAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21&#44;22</span></a> Such histologic patterns of lung injury define AFOP&#8212;first described in 2002 by Beasley et al&#46;&#8212;as a possible variant of DAD because of its similar aggressive behavior and mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> Nowadays&#44; AFOP is not considered as a specific entity&#44; but rather as a histological pattern that can occur in lung tissues from patients with clinical&#47;radiological pictures of either DAD or OP&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">24&#44;25</span></a> It sometimes follows an aggressive course&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> Finding it is not completely unexpected&#44; since this type of lung injury was previously found in SARS-CoV-1 positive cases&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> Moreover&#44; Copin et al&#46; described AFOP on post-mortem biopsies and concluded that lung injury in severe SARS-CoV2 infection is not a DAD&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a> These lung lesions are therefore rather a fibrinous variant of DAD with AFOP features&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">ARDS is a clinical syndrome introduced for the first time in the medical literature in 1967&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> In the management of &#8220;typical&#8221; ARDS&#44; the use of corticosteroids remains controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">31</span></a> However&#44; in our work&#44; the analysis of lung biopsies in patients who died of ARDS related to COVID-19 revealed a high incidence of acute fibrinous and organizing pneumonia &#40;AFOP&#41; features &#40;50&#37; of all patients&#41;&#46; These cortico-sensitive lesions were described from the second week of ICU&#44; while the presence of the virus was no longer detected&#46; Thus&#44; whether corticosteroids are beneficial at this timing should be questioned&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The presence of AFOP features&#8212;which is uncommon in ARDS&#8212;could add some knowledge to understand why several reports suggest that ARDS related to COVID-19 is different from typical ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5&#44;6&#44;32</span></a> Moreover&#44; consistent with our study&#44; lung lesions seem to evolve during the time course of the disease&#44; suggesting that the same treatment could have a different impact depending on when it started&#46; Indeed&#44; contrary to the fulminant presentation of AFOP&#44; the subacute presentation is a potentially cortico-sensitive state&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">33&#44;34</span></a> Thus&#44; understanding the chronology of lesion onset is fundamental to determine the best time to introduce a potential treatment&#44; such as corticosteroids or maybe other immunosuppressive therapies&#46; Hence&#44; corticosteroids could potentially be beneficial in the early stages of ARDS by reducing inflammation&#44; by modulating cytokine storm<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">35</span></a> but also by acting on AFOP&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">36</span></a> Our results could partly explain the results of the RECOVERY trial&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">37</span></a> which provides evidence that treatment with dexamethasone reduces 28-day mortality in patients with COVID-19 receiving respiratory support&#46; This study did not uncover any benefit but&#44; on the contrary&#44; there seemed to be an increased risk of death in patients with a mild form of COVID-19 who did not require oxygen&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our present data show the occurrence of end-stage fibrosis in 100&#37; of the patients after 3 weeks of ventilation appearing to be more important than in usual ARDS&#44; where 42&#37; of patients had fibrosis in extrapulmonary ARDS and 82&#37; in pulmonary ARDS after 3 weeks of ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> Thus&#44; deceased patients after severe forms of COVID-19 appear to have more pro-fibrotic activity and survivors who have been on mechanical ventilation for several days are potentially at risk of developing pulmonary fibrosis leading to potential restrictive lung disease&#44; as reported in SARS-CoV-1<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">38</span></a> and MERS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">39</span></a> Thereby&#44; one could suggest that VAP might worsen the established histopathological injuries and facilitate the progression toward fibrosis in COVID-19 pneumonia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A recent case-control study by Konopka concluded that there are no distinctive morphologic features to confidently differentiate COVID-19-related DAD from DAD due to other causes&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">40</span></a> However&#44; this is a study based on few autopsies&#44; with the limitations that it implies compared to early post-mortem biopsies&#46; Furthermore&#44; these results do not seem to be in agreement with the medical literature on ARDS where AFOP lesions are uncommon&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> Although RT-PCR testing for the virus in tracheobronchial secretions was positive up to death in the majority of our patients&#44; no histological trace of the virus was found in patients who died after the first week&#46; The presence of viral RT-PCR in the patients&#8217; tracheobronchial secretions does not necessarily indicate the presence of infectious virus&#44; as it has been demonstrated in other organs&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">41</span></a> These results are consistent with other histological studies in which less frequently&#44; SARS-COV-2 were seen beyond 2 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">42&#44;43</span></a> One explanation is that SARS-COV-2 replicates faster&#44; more efficiently and to a greater extent in the epithelial cells of the nasal cavity than in the alveoli&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">44</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">As in the study by Ackermann et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a> we found very few neutrophils in lungs&#46; But we did not find CD4-positive T cells being always more numerous than CD8-positive T cells&#46; In some patients&#44; we even observed the opposite&#46; The CD4&#47;CD8-positive T cells ratio did not correlate with the duration of ICU stay or the use of corticosteroids&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Some studies have shown endothelial cell infection and endotheliitis in COVID-19&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">46</span></a> as well as coagulation disorders with a higher than average risk of life-threatening thrombotic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">47</span></a> However&#44; we found no evidence of endothelial cell infection and only one patient had evidence of endotheliitis&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first report assessing immediate samples of lung biopsies following death&#44; which could make our histological analysis much more accurate as stated by others&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a> This is in contrast to most studies in which autopsies were performed several days after death&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">45&#44;48</span></a> Hence&#44; post-mortem autolysis could be one of the explanations why some studies find the presence of DAD&#44; without predominant AFOP features&#46; It is also the first study to investigate the chronology of injuries&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Some limitations can be advanced&#46; The main one is the absence of a control group&#44; given the urgency of the situation&#46; The sample size was small compared to autopsy cases&#46; This could in fact explain why we have a lower incidence of vascular thrombosis and endotheliitis in our series&#44; especially in needle biopsies which are less prone to collect pulmonary arteries or veins&#46; On the opposite&#44; needle biopsies taken in different lobes well reflect the heterogeneity of the disease and help to illustrate the variety of morphological features&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Chronological evolution of COVID-19 lung histopathologic lesions seems to be close to other ARDS&#46; COVID-19 ARDS seems to be more prone to evolve towards pulmonary fibrosis after 3 weeks than other ARDS&#46; Moreover&#44; there are notably pulmonary injuries consistent with potentially corticosteroid-sensitive lesions&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Authors&#8217; contributions</span><p id="par0180" class="elsevierStylePara elsevierViewall">All authors whose names appear on the submission contributed substantially to the conception and design of the study&#44; the acquisition of data or the analysis and interpretation of the data&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">HM&#44; MS&#44; WO&#44; RCJ&#44; SC&#44; JEH&#44; RJL&#44; JH&#44; FM have been involved in the care of patients and performed lung biopsies&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">SM&#44; AN and MPC performed the histopathological analyses&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">HM&#44; FM and MPC collected the data and wrote the manuscript&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">FM and MPC contributed equally to this work&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Data availability</span><p id="par0205" class="elsevierStylePara elsevierViewall">All available data are published in the current manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Ethical approval</span><p id="par0210" class="elsevierStylePara elsevierViewall">The local ethics committee of the University Hospital of Strasbourg approved the study &#40;reference CE-2020-34&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Consent for publication</span><p id="par0215" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This work has been supported by the <span class="elsevierStyleGrantSponsor" id="gs1">Association for Research Development in Intensive Care &#40;ADRER&#41;</span>&#44; Strasbourg&#44; France&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Histologic examination"
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              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Baseline characteristics of the patients"
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            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Clinical description of the patients"
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            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Histologic patterns"
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              "titulo" => "Immune cell population"
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            4 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Viral status in lung tissue"
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            5 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Endothelial and microcirculation injury"
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          "titulo" => "Discussion"
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          "titulo" => "Authors&#8217; contributions"
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          "titulo" => "Data availability"
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          "titulo" => "Ethical approval"
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          "identificador" => "sec0090"
          "titulo" => "Consent for publication"
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          "titulo" => "Conflicts of interest"
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          "identificador" => "xack530018"
          "titulo" => "Acknowledgment"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2021-01-01"
    "fechaAceptado" => "2021-02-05"
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          "clase" => "keyword"
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            0 => "COVID-19"
            1 => "SARS-CoV-2"
            2 => "COVID-19 related acute respiratory distress syndrome"
            3 => "Histopathology"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1369733"
          "palabras" => array:12 [
            0 => "COVID-19"
            1 => "ACE2"
            2 => "ARDS"
            3 => "VILI"
            4 => "HE"
            5 => "DAD"
            6 => "AFOP"
            7 => "ISH"
            8 => "SAPSII"
            9 => "SOFA"
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            0 => "COVID-19"
            1 => "SARS-CoV-2"
            2 => "S&#237;ndrome de dificultad respiratoria aguda asociada a COVID-19"
            3 => "Histopatolog&#237;a"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">COVID-19 acute respiratory distress syndrome &#40;ARDS&#41; shares the common histological hallmarks with other forms of ARDS&#46; However&#44; the chronology of the histological lesions has not been well established&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study was carried out&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Setting</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Unit of a tertiary hospital&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The first 22 consecutive COVID-19 deaths&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Measurements</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS&#46; Clinical data and patient course were evaluated&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The median patient age was 66 &#91;63&#8211;74&#93; years&#59; 73&#37; were males&#46; The median duration of mechanical ventilation was 17 &#91;8&#8211;24&#93; days&#46; COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease&#44; followed by a proliferative&#47;organizing phase in the second and third weeks&#44; and finally an end-stage fibrosis phase after the third week&#46; Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease&#44; and were no longer detected after the second week&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Limitation</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Limited sample size&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS&#46; In particular&#44; lung lesions consistent with potentially corticosteroid-sensitive lesions are seen&#46;</p></span>"
        "secciones" => array:9 [
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            "titulo" => "Limitation"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Antecedentes</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de dificultad respiratoria aguda &#40;SDRA&#41; asociado a la COVID-19 comparte caracter&#237;sticas histol&#243;gicas con otros tipos de SDRA&#46; Sin embargo&#44; no se ha establecido adecuadamente la cronolog&#237;a de las lesiones histol&#243;gicas&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Describir las alteraciones histopatol&#243;gicas cronol&#243;gicas en los pulmones de los pacientes con s&#237;ndrome de dificultad respiratoria aguda asociado a COVID-19&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Dise&#241;o</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de cohortes&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">&#193;mbito</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Unidad de cuidados intensivos de un hospital terciario&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Las primeras 22 muertes consecutivas por COVID-19&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intervenciones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se llevaron a cabo biopsias pulmonares y an&#225;lisis histopatol&#243;gicos en pacientes fallecidos por SDRA asociado a COVID-19&#46; Se evaluaron los datos cl&#237;nicos y la evoluci&#243;n m&#233;dica&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad de los pacientes fue de 66 &#40;63-74&#41; a&#241;os y el 73&#37; eran varones&#46; La mediana de la duraci&#243;n de la ventilaci&#243;n mec&#225;nica fue de 17 &#40;8-24&#41; d&#237;as&#46; La lesi&#243;n pulmonar inducida por COVID-19 se caracteriz&#243; por una fase exudativa durante la primera semana de la enfermedad&#44; seguida de una fase proliferativa&#47;organizativa en la segunda y tercera semana y&#44; por &#250;ltimo&#44; una fase de fibrosis en fase terminal tras la tercera semana de evoluci&#243;n&#46; Se detectaron prote&#237;nas y ARN v&#237;rico en neumocitos y macr&#243;fagos en una fase muy temprana de la enfermedad&#44; pero estos ya no se volvieron a detectar a partir de la segunda semana&#46;</p></span> <span id="abst0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitaci&#243;n</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tama&#241;o limitado de la muestra&#46;</p></span> <span id="abst0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusi&#243;n</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La evoluci&#243;n cronol&#243;gica de las lesiones histopatol&#243;gicas pulmonares asociadas a la COVID-19 parece ser similar a la de otras formas de SDRA&#46; En particular&#44; se observan da&#241;os pulmonares coherentes con las lesiones potencialmente sensibles a los corticosteroides&#46;</p></span>"
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            "titulo" => "Dise&#241;o"
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            "titulo" => "Limitaci&#243;n"
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          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Detection of SARS-CoV-2 and characterization of inflammation&#46; &#40;A&#41; Edema of alveolar walls and atypical pneumocytes with enlarged nuclei &#40;arrow&#41;&#46; Hematoxylin&#8211;eosin staining&#46; &#40;B&#41; SARS-Cov-2 mRNA detection in atypical pneumocytes by <span class="elsevierStyleItalic">in situ</span> hybridization&#46; &#40;C&#41; Viral nucleocapsid protein detection in atypical pneumocytes by immunohistochemistry&#46; &#40;D&#41; Multiplex chromogenic detection by DAB staining &#40;brown&#41; of CD20&#43; lymphocytes&#44; purple staining of CD8&#43; lymphocytes&#44; teal staining &#40;blue&#41; of CD4&#43; lymphocytes and yellow staining of macrophages&#46; CD4&#43; lymphocytes outnumber CD8&#43; lymphocytes in this case&#46; The scale bar corresponds to 50<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;</p>"
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                  \t\t\t\t">66 &#91;63&#8211;73&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obese &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Currently smocker patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;22 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;22 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;22 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kidney graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;22 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;22 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SAPS II&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#91;47&#8211;67&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration of mechanical ventilation&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#91;8&#8211;23&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NeuroMuscular Blocking Drugs &#40;NMBD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;22 &#40;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prone position&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;22 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Steroid therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;22 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Veno-venous Extracorporeal Membrane Oxygenation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;22 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory results collected at admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leukocytes&#44; 10<span class="elsevierStyleSup">9</span>&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#91;5&#46;6&#8211;14&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphocytes&#44; 10<span class="elsevierStyleSup">9</span>&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#91;0&#46;2&#8211;0&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRP&#44; mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;1 &#91;110&#46;9&#8211;182&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCT&#44; &#956;g&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2 &#91;0&#46;48&#8211;3&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">511&#46;5 &#91;449&#46;2&#8211;562&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial lactate&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4 &#91;1&#8211;2&#46;3&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D-dimeres&#44; &#956;g&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2320 &#91;980&#8211;4050&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;6 &#91;0&#46;5&#8211;0&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#91;10&#8211;14&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pplat&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5 &#91;22&#8211;26&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Driving pressure&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#91;9&#8211;14&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;5 &#91;120&#46;2&#8211;182&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#91;29&#46;4&#8211;42&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventilatory parameters collected at time of death</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#91;0&#46;45&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#91;5&#8211;10&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pplat&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#91;26&#8211;31&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Driving pressure&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#91;16&#8211;24&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 &#91;71&#8211;217&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#91;15&#8211;24&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fibrosis &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No fibrosis &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">General characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#91;64&#46;5&#8211;73&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#91;58&#8211;71&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SAPS II&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#91;43&#46;7&#8211;61&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#91;54&#46;7&#8211;69&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration of mechanical ventilation&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#91;20&#8211;29&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#91;5&#46;75&#8211;11&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Steroid therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Delay between the onset of ventilation and start of steroids&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;4&#8211;15&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#91;2&#8211;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventilatory parameters collected at time of death</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97 &#91;0&#46;42&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#91;0&#46;5&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6 &#91;5&#8211;7&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;5&#8211;10&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 &#91;72&#8211;219&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#91;76&#8211;191&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#91;14&#8211;23&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#91;18&#8211;24&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Steroids &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No Steroids &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Histologic features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Near-normal lung architecture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudative phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Proliferative&#47;organizing phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrosis phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute fibrinous and organizing pneumonia &#40;AFOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VAP &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No VAP &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Histologic features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Near-normal lung architecture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudative phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Proliferative&#47;organizing phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrosis phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute fibrinous and organizing pneumonia &#40;AFOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Histologic features of 22 patients who developed a ventilator-associated pneumonia &#40;VAP&#41; and those who did not&#46;</p>"
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              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AFOP &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No AFOP &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">General characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#91;65&#8211;73&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#91;62&#46;5&#8211;72&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SAPS II&#44; points&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">58 &#91;41&#46;5&#8211;62&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration of mechanical ventilation&#44; days&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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Original article
Histopathological features in fatal COVID-19 acute respiratory distress syndrome
Características hispotatológicas en el síndrome de dificultad respiratoria aguda asociado a COVID-19 mortal
H. Merdjia,b, S. Mayeurc, M. Schenckd, W. Oulehrie,f, R. Clere-Jehla,g, S. Cunata, J.-E. Herbrechtd, R. Janssen-Langensteind, A. Nicolaec, J. Helmsa,g, F. Meziania,b,
Autor para correspondencia
, M.-P. Chenardc,h, for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care, Sepsis Trial Group for Global Evaluation, Research in Sepsis)
a Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
b INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
c Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
d Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
e Service d’Anesthésie - Réanimation Chirurgicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
f Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
g ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
h Centre de Ressources biologiques, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Leído
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acute respiratory distress syndrome &#40;ARDS&#41; phenotypes&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5&#8211;7</span></a> Thus&#44; pulmonary radiology studies in COVID-19 showed lesions more similar to organizing pneumonia&#44; especially in the early stages of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8&#44;9</span></a> Although several studies have now described clinical&#44; radiographic and pathologic features of COVID-19&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">10&#44;11</span></a> no studies have been conducted on the basis of early biopsies in the deceased&#46; Some of the reasons for the lack of biopsies include suddenness of the outbreak&#44; massive influx of patients in hospitals&#44; shortage of medical staff&#44; and high rate of transmission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The present study has been designed to assess the chronology of histologic features of SARS-CoV-2-induced pulmonary disease&#44; by analyzing immediate postmortem transthoracic biopsies performed in patients hospitalized in intensive care unit for severe forms of COVID-19&#46; Indeed&#44; in a recent report&#44; Sapino et al&#46; suggested that tissue sampling using biopsies may be an interesting and safer alternative to autopsy for research projects during outbreaks such as COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">Between March 25&#44; 2020 and May 2&#44; 2020&#44; all patients who died from ARDS related to COVID-19 were prospectively included in four intensive care units &#40;ICUs&#41; in two centers of a French tertiary hospital in Strasbourg&#46; During their ICU stay&#44; patients were treated in accordance with standard practice and ventilated with protective ventilation to reduce the risk of ventilator induced lung injury &#40;VILI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">13</span></a> There was no exclusion criterion&#46; Trained intensivists performed lung biopsies at bedside within the hour following death&#46; The area to be biopsied was selected based on the lung injuries on the most recent imaging and the procedure was carried out under ultrasound guidance&#46; All lung biopsies were analyzed at the hospital&#39;s Department of Pathology for histopathologic evaluation&#46; Medical conditions and medications&#44; current medical course&#44; and antemortem diagnostic findings were recorded&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study was approved by the local ethics committee of the University Hospital of Strasbourg &#40;reference CE-2020-34&#41;&#46; Approval for the post-mortem biopsies was obtained from the biomedical agency and the French ministry of research&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Histologic examination</span><p id="par0025" class="elsevierStylePara elsevierViewall">Tissue samples for histopathologic analysis were immediately fixed in 4&#37; neutral buffered formalin for 24<span class="elsevierStyleHsp" style=""></span>h&#44; which ensures inactivation of the virus&#44; and then processed via standard procedure to slides stained with hematoxylin&#8211;eosin &#40;HE&#41;&#44; Masson&#39;s trichrome&#44; PAS and Perls staining&#46; All the samples were blindly analyzed by an experienced pathologist&#44; trained in pulmonary pathology&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Microscopic examination included a systematic search of the histologic criteria described at the 3 phases of diffuse alveolar damage &#40;DAD&#41;&#44; the histological hallmark for ARDS&#46; Capillary congestion&#44; intra-alveolar edema&#44; loose fibrin deposition and hyaline membranes were considered as exudative changes&#46; Type II pneumocyte hyperplasia&#44; alveolar septa thickening with fibroblast proliferation and organizing fibroblastic tissue in air spaces were considered as features of the proliferative&#47;organizing phase&#46; Prominent interstitial collagenous fibrosis with architectural remodeling and&#47;or honeycomb-like change defined the fibrotic phase&#46; Extensive intra-alveolar fibrin deposition forming fibrin &#8220;balls&#8221; in alveolar ducts and alveoli&#44; coexisting with intraluminal loose connective tissue polyps were histologic criteria of acute fibrinous and organizing pneumonia &#40;AFOP&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Interstitial and intra-alveolar inflammatory infiltrate was analyzed using an automated chromogenic multiplexed immunohistochemistry assay on the Discovery Ultra automated immunostainer &#40;Ventana Medical Systems&#44; Tucson&#44; AZ&#44; USA&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">14</span></a> with four antibodies targeting CD4&#44; CD8&#44; CD20 and CD68&#46; Presence of SARS-CoV-2 virus in the lung tissue sections was evaluated by <span class="elsevierStyleItalic">in situ</span> hybridization &#40;ISH&#41; using RNAscope technology with a SARS-Cov-2 spike probe to COVID-19 coronavirus<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">15</span></a> and by immunohistochemistry with a polyclonal Sars nucleocapsid protein antibody &#40;200-401-A50&#59; Rockland Immunochemicals&#44; Inc&#46;&#44; USA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of this study is descriptive&#46; No formal hypothesis was implemented to drive the sample size calculation and the maximum number of patients who met the inclusion criteria was included&#46; Descriptive data were expressed as mean &#40;SD&#41; or median &#40;IQR&#41; for continuous variables and categorical variables as number &#40;&#37;&#41;&#46; Tests were two-sided with significance set at <span class="elsevierStyleItalic">&#945;</span> less than 0&#46;05&#46; Differences between groups were considered to be significant at a <span class="elsevierStyleItalic">P</span> value of<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Students&#8217; <span class="elsevierStyleItalic">t</span>-test was performed to compare two groups sampled from normal distributions with equal variances&#46; One-way analysis of variance &#40;one-way ANOVA&#41; was used to compare means of more than two groups&#46; Statistical analyses were performed with GraphPad Prism 8 &#40;GraphPad Software&#44; Inc&#46;&#44; San Diego&#44; CA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Baseline characteristics of the patients</span><p id="par0045" class="elsevierStylePara elsevierViewall">A Total of 183 patients were admitted in ICU during this period&#46; Twenty-two patients were included in this study&#46; Median age was 66 &#91;63&#8211;74&#93; years&#46; 16&#47;22 &#40;73&#37;&#41; patients were male&#46; Predominant medical history of these patients was overweight and obesity&#46; Few patients were active smokers&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> provides an overview of initial laboratory results&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> provides an overview of ventilatory parameters at admission and at time of death&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Clinical description of the patients</span><p id="par0050" class="elsevierStylePara elsevierViewall">Median SAPS II and SOFA scores on admission in ICU were respectively 58 &#91;47&#8211;67&#93; and 11 &#91;8&#8211;15&#93;&#46; The median duration of mechanical ventilation was 17 &#91;8&#8211;24&#93; days&#46; 20&#47;22 patients &#40;91&#37;&#41; received neuromuscular blocking drugs &#40;NMBD&#41; with a median of 8 &#91;6&#8211;15&#93; days&#46; 11&#47;22 patients &#40;50&#37;&#41; received inhaled nitric oxide&#46; 13&#47;22 patients &#40;59&#37;&#41; developed ventilator-associated pneumonia &#40;VAP&#41;&#46; 11&#47;22 &#40;50&#37;&#41; patients received corticosteroids for a median of 9 &#91;7&#8211;10&#93; days&#46; Median dynamic respiratory system compliance at death was 21 &#91;15&#8211;24&#93;<span class="elsevierStyleHsp" style=""></span>mL&#47;cmH<span class="elsevierStyleInf">2</span>O&#46; 5&#47;22 patients &#40;23&#37;&#41; received veno-venous extracorporeal membrane oxygenation &#40;VV-ECMO&#41;&#46; 8&#47;22 patients &#40;36&#37;&#41; developed a pulmonary embolism&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were stratified according to the delay since the beginning of clinical criteria for ARDS related to COVID-19&#58; 4 &#40;18&#37;&#41; patients with severe pneumonia for less than 1 week&#44; 11 &#40;50&#37;&#41; patients between 1 and 3 weeks&#44; and 7 &#40;32&#37;&#41; patients for more than 3 weeks&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the four patients who died during the first week&#44; one died of cardiac arrest induced by tension pneumothorax and three had limit in therapeutic effort &#40;one because of Ewing Sarcoma and multiple myeloma&#44; one because of acute promyelocytic leukemia with stroke and one because of multiple organ failure due to COVID-19 and a <span class="elsevierStyleItalic">staphylococcus aureus</span> VAP&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Histologic patterns</span><p id="par0065" class="elsevierStylePara elsevierViewall">The average number of lung tissue probes obtained by needle biopsies from different lobes was 9&#46;4&#46; As expected&#44; histologic features of exudative&#44; proliferative and fibrotic phase of DAD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows different histological findings&#41; were observed&#46; Time to onset of histological lesions was closely related to the duration of evolution of ARDS related to COVID-19 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Exudative changes were present in 3 of the 4 patients &#40;75&#37;&#41; within the first week of ARDS related to COVID-19&#44; 8 of the 11 patients &#40;72&#37;&#41; within the second and third weeks&#44; and none of the 7 patients with more than 3 weeks of evolution &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Intra-alveolar loose fibrin exudate and hyaline membranes gradually decreased over weeks &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01 respectively&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">By contrast&#44; the incidence of proliferative changes increased over time and were reported in 2&#47;4 patients &#40;50&#37;&#41; within the first week&#44; 8&#47;11 patients &#40;73&#37;&#41; within the 1&#8211;3 weeks&#44; and 6&#47;7 patients &#40;88&#37;&#41; after the third week &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Hyperplasia of type II pneumocytes mostly with cytologic atypia was noted in 17 of the 19 patients &#40;89&#37;&#41; presenting proliferative changes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of end-stage fibrosis increased over time&#58; the pattern appeared in none of the 4 patients with disease for less than 1 week&#44; in 3 of the 11 patients &#40;27&#37;&#41; with disease for 1&#8211;3 weeks&#44; and in all &#40;100&#37;&#41; of the patients with a disease of more than 3 weeks &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Patients with end-stage fibrosis had been on mechanical ventilation for a longer period of time than patients without fibrosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; It should be noted that histological criteria of more than one phase coexisted in 16 of 22 patients &#40;73&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">No differences in histologic findings were observed between patients who received steroids and those who did not &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Regarding patients who developed a VAP and those who did not&#44; there was significantly more fibrosis in the patients who developed VAP &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Features of AFOP were found in 10 patients &#40;45&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; They began to appear during the second&#8211;third week in 36&#37; of the patients&#44; with a large number of fibrin balls&#59; and were found in 86&#37; of the patients after the third week &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; showing remnants of fibrin plugs associated with loose fibrous polyps of organizing pneumonia &#40;OP&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Immune cell population</span><p id="par0090" class="elsevierStylePara elsevierViewall">Interstitial inflammatory infiltrate was found in all patients regardless of the duration of ventilation&#46; It was mostly mild to moderate&#44; and composed of lymphocytes with some monocytes&#46; Plasma cells were present after the third week&#46; Neutrophils were scarce&#46; Endo-alveolar infiltrate was present in 19&#47;22 &#40;86&#37;&#41; of patients and almost exclusively composed by macrophages&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Immune cell subpopulations were analyzed in 12&#47;22 cases &#40;from day 1 to day 25 after ventilation&#41; using an automated chromogenic multiplexed immunohistochemistry &#40;IHC&#41; assay with four antibodies &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In all cases only rare scattered interstitial CD20&#43; B-cells were observed&#46; The infiltrate consisted of T-cells&#44; with a mixture of CD4&#43; and CD8&#43; lymphocytes&#46; There were slightly more CD4&#43; than CD8&#43; lymphocytes in 6&#47;12 &#40;50&#37;&#41;&#44; and slightly more CD8&#43; than CD4&#43; lymphocytes in 6&#47;12 &#40;50&#37;&#41; of patients&#46; CD68&#43; macrophages were mostly located in alveolar spaces&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Viral status in lung tissue</span><p id="par0100" class="elsevierStylePara elsevierViewall">The presence of the SARS-CoV2&#8212;tested by immunohistochemistry &#40;IHC&#41;&#8212;was only found in 2&#47;22 patients &#40;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Both died early&#44; during the first week of ICU stay&#44; after 4 and 7 days of symptomatic illness&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As IHC&#44; RNA scope allowed detection of SARS-CoV-2 viral RNA only in the two same patients &#40;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Both viral RNA and protein were located in atypical pneumocytes and in some intra-alveolar macrophages&#46; No staining of endothelial cells could be identified&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although RT-PCR testing for the virus in tracheobronchial secretions was positive up until death in the majority of our patients &#40;20&#47;22 patients&#41;&#8212;using the two methods &#40;IHC and RNAscope&#41;&#8212;no trace of the virus was found in lung tissue of patients who died after the first week&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Endothelial and microcirculation injury</span><p id="par0120" class="elsevierStylePara elsevierViewall">Even if 8&#47;22 patients &#40;36&#37;&#41; developed a pulmonary embolism&#44; only two of the 22 patients had recent thrombosis of small pulmonary arteries and one patient had endotheliitis in lung vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; To note&#44; all patients received heparin therapy&#46; Six received prophylactic anticoagulation &#40;27&#46;3&#37;&#41; and 16 therapeutic anticoagulation &#40;72&#46;7&#37;&#41;&#46; Other common findings were diffuse small vessel platelet aggregation&#44; intra-alveolar hemorrhage or areas of hemorrhagic necrosis of the lung parenchyma&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Herein&#44; we report the histopathological features of SARS-CoV-2-induced pulmonary disease&#46; Although this ARDS is typical in term of histological injuries and chronology&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">18</span></a> it is characterized by predominant acute fibrinous and organizing pneumonia &#40;AFOP&#41; and potential more pro-fibrotic evolution&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As described by Katzenstein et al&#46; in 1976&#44; the histological hallmark of ARDS is diffuse alveolar damage &#40;DAD&#41;&#44; consisting of changes such as hyaline membranes&#44; interstitial edema&#44; cell necrosis and proliferation&#44; or&#47;and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a> In our series&#44; such changes were present&#44; but the predominant feature was loose fibrin deposition and&#47;or fibrin balls within the alveolar spaces&#44; that evolved towards organizing pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a> which is uncommon in classic DAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21&#44;22</span></a> Such histologic patterns of lung injury define AFOP&#8212;first described in 2002 by Beasley et al&#46;&#8212;as a possible variant of DAD because of its similar aggressive behavior and mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> Nowadays&#44; AFOP is not considered as a specific entity&#44; but rather as a histological pattern that can occur in lung tissues from patients with clinical&#47;radiological pictures of either DAD or OP&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">24&#44;25</span></a> It sometimes follows an aggressive course&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> Finding it is not completely unexpected&#44; since this type of lung injury was previously found in SARS-CoV-1 positive cases&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> Moreover&#44; Copin et al&#46; described AFOP on post-mortem biopsies and concluded that lung injury in severe SARS-CoV2 infection is not a DAD&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a> These lung lesions are therefore rather a fibrinous variant of DAD with AFOP features&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">ARDS is a clinical syndrome introduced for the first time in the medical literature in 1967&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> In the management of &#8220;typical&#8221; ARDS&#44; the use of corticosteroids remains controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">31</span></a> However&#44; in our work&#44; the analysis of lung biopsies in patients who died of ARDS related to COVID-19 revealed a high incidence of acute fibrinous and organizing pneumonia &#40;AFOP&#41; features &#40;50&#37; of all patients&#41;&#46; These cortico-sensitive lesions were described from the second week of ICU&#44; while the presence of the virus was no longer detected&#46; Thus&#44; whether corticosteroids are beneficial at this timing should be questioned&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The presence of AFOP features&#8212;which is uncommon in ARDS&#8212;could add some knowledge to understand why several reports suggest that ARDS related to COVID-19 is different from typical ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5&#44;6&#44;32</span></a> Moreover&#44; consistent with our study&#44; lung lesions seem to evolve during the time course of the disease&#44; suggesting that the same treatment could have a different impact depending on when it started&#46; Indeed&#44; contrary to the fulminant presentation of AFOP&#44; the subacute presentation is a potentially cortico-sensitive state&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">33&#44;34</span></a> Thus&#44; understanding the chronology of lesion onset is fundamental to determine the best time to introduce a potential treatment&#44; such as corticosteroids or maybe other immunosuppressive therapies&#46; Hence&#44; corticosteroids could potentially be beneficial in the early stages of ARDS by reducing inflammation&#44; by modulating cytokine storm<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">35</span></a> but also by acting on AFOP&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">36</span></a> Our results could partly explain the results of the RECOVERY trial&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">37</span></a> which provides evidence that treatment with dexamethasone reduces 28-day mortality in patients with COVID-19 receiving respiratory support&#46; This study did not uncover any benefit but&#44; on the contrary&#44; there seemed to be an increased risk of death in patients with a mild form of COVID-19 who did not require oxygen&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our present data show the occurrence of end-stage fibrosis in 100&#37; of the patients after 3 weeks of ventilation appearing to be more important than in usual ARDS&#44; where 42&#37; of patients had fibrosis in extrapulmonary ARDS and 82&#37; in pulmonary ARDS after 3 weeks of ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> Thus&#44; deceased patients after severe forms of COVID-19 appear to have more pro-fibrotic activity and survivors who have been on mechanical ventilation for several days are potentially at risk of developing pulmonary fibrosis leading to potential restrictive lung disease&#44; as reported in SARS-CoV-1<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">38</span></a> and MERS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">39</span></a> Thereby&#44; one could suggest that VAP might worsen the established histopathological injuries and facilitate the progression toward fibrosis in COVID-19 pneumonia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A recent case-control study by Konopka concluded that there are no distinctive morphologic features to confidently differentiate COVID-19-related DAD from DAD due to other causes&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">40</span></a> However&#44; this is a study based on few autopsies&#44; with the limitations that it implies compared to early post-mortem biopsies&#46; Furthermore&#44; these results do not seem to be in agreement with the medical literature on ARDS where AFOP lesions are uncommon&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> Although RT-PCR testing for the virus in tracheobronchial secretions was positive up to death in the majority of our patients&#44; no histological trace of the virus was found in patients who died after the first week&#46; The presence of viral RT-PCR in the patients&#8217; tracheobronchial secretions does not necessarily indicate the presence of infectious virus&#44; as it has been demonstrated in other organs&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">41</span></a> These results are consistent with other histological studies in which less frequently&#44; SARS-COV-2 were seen beyond 2 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">42&#44;43</span></a> One explanation is that SARS-COV-2 replicates faster&#44; more efficiently and to a greater extent in the epithelial cells of the nasal cavity than in the alveoli&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">44</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">As in the study by Ackermann et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a> we found very few neutrophils in lungs&#46; But we did not find CD4-positive T cells being always more numerous than CD8-positive T cells&#46; In some patients&#44; we even observed the opposite&#46; The CD4&#47;CD8-positive T cells ratio did not correlate with the duration of ICU stay or the use of corticosteroids&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Some studies have shown endothelial cell infection and endotheliitis in COVID-19&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">46</span></a> as well as coagulation disorders with a higher than average risk of life-threatening thrombotic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">47</span></a> However&#44; we found no evidence of endothelial cell infection and only one patient had evidence of endotheliitis&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first report assessing immediate samples of lung biopsies following death&#44; which could make our histological analysis much more accurate as stated by others&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a> This is in contrast to most studies in which autopsies were performed several days after death&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">45&#44;48</span></a> Hence&#44; post-mortem autolysis could be one of the explanations why some studies find the presence of DAD&#44; without predominant AFOP features&#46; It is also the first study to investigate the chronology of injuries&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Some limitations can be advanced&#46; The main one is the absence of a control group&#44; given the urgency of the situation&#46; The sample size was small compared to autopsy cases&#46; This could in fact explain why we have a lower incidence of vascular thrombosis and endotheliitis in our series&#44; especially in needle biopsies which are less prone to collect pulmonary arteries or veins&#46; On the opposite&#44; needle biopsies taken in different lobes well reflect the heterogeneity of the disease and help to illustrate the variety of morphological features&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Chronological evolution of COVID-19 lung histopathologic lesions seems to be close to other ARDS&#46; COVID-19 ARDS seems to be more prone to evolve towards pulmonary fibrosis after 3 weeks than other ARDS&#46; Moreover&#44; there are notably pulmonary injuries consistent with potentially corticosteroid-sensitive lesions&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Authors&#8217; contributions</span><p id="par0180" class="elsevierStylePara elsevierViewall">All authors whose names appear on the submission contributed substantially to the conception and design of the study&#44; the acquisition of data or the analysis and interpretation of the data&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">HM&#44; MS&#44; WO&#44; RCJ&#44; SC&#44; JEH&#44; RJL&#44; JH&#44; FM have been involved in the care of patients and performed lung biopsies&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">SM&#44; AN and MPC performed the histopathological analyses&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">HM&#44; FM and MPC collected the data and wrote the manuscript&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">FM and MPC contributed equally to this work&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Data availability</span><p id="par0205" class="elsevierStylePara elsevierViewall">All available data are published in the current manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Ethical approval</span><p id="par0210" class="elsevierStylePara elsevierViewall">The local ethics committee of the University Hospital of Strasbourg approved the study &#40;reference CE-2020-34&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Consent for publication</span><p id="par0215" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This work has been supported by the <span class="elsevierStyleGrantSponsor" id="gs1">Association for Research Development in Intensive Care &#40;ADRER&#41;</span>&#44; Strasbourg&#44; France&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">COVID-19 acute respiratory distress syndrome &#40;ARDS&#41; shares the common histological hallmarks with other forms of ARDS&#46; However&#44; the chronology of the histological lesions has not been well established&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study was carried out&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Setting</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Unit of a tertiary hospital&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The first 22 consecutive COVID-19 deaths&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Measurements</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS&#46; Clinical data and patient course were evaluated&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The median patient age was 66 &#91;63&#8211;74&#93; years&#59; 73&#37; were males&#46; The median duration of mechanical ventilation was 17 &#91;8&#8211;24&#93; days&#46; COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease&#44; followed by a proliferative&#47;organizing phase in the second and third weeks&#44; and finally an end-stage fibrosis phase after the third week&#46; Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease&#44; and were no longer detected after the second week&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Limitation</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Limited sample size&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS&#46; In particular&#44; lung lesions consistent with potentially corticosteroid-sensitive lesions are seen&#46;</p></span>"
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        "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Antecedentes</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de dificultad respiratoria aguda &#40;SDRA&#41; asociado a la COVID-19 comparte caracter&#237;sticas histol&#243;gicas con otros tipos de SDRA&#46; Sin embargo&#44; no se ha establecido adecuadamente la cronolog&#237;a de las lesiones histol&#243;gicas&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Describir las alteraciones histopatol&#243;gicas cronol&#243;gicas en los pulmones de los pacientes con s&#237;ndrome de dificultad respiratoria aguda asociado a COVID-19&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Dise&#241;o</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de cohortes&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">&#193;mbito</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Unidad de cuidados intensivos de un hospital terciario&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Las primeras 22 muertes consecutivas por COVID-19&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intervenciones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se llevaron a cabo biopsias pulmonares y an&#225;lisis histopatol&#243;gicos en pacientes fallecidos por SDRA asociado a COVID-19&#46; Se evaluaron los datos cl&#237;nicos y la evoluci&#243;n m&#233;dica&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad de los pacientes fue de 66 &#40;63-74&#41; a&#241;os y el 73&#37; eran varones&#46; La mediana de la duraci&#243;n de la ventilaci&#243;n mec&#225;nica fue de 17 &#40;8-24&#41; d&#237;as&#46; La lesi&#243;n pulmonar inducida por COVID-19 se caracteriz&#243; por una fase exudativa durante la primera semana de la enfermedad&#44; seguida de una fase proliferativa&#47;organizativa en la segunda y tercera semana y&#44; por &#250;ltimo&#44; una fase de fibrosis en fase terminal tras la tercera semana de evoluci&#243;n&#46; Se detectaron prote&#237;nas y ARN v&#237;rico en neumocitos y macr&#243;fagos en una fase muy temprana de la enfermedad&#44; pero estos ya no se volvieron a detectar a partir de la segunda semana&#46;</p></span> <span id="abst0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitaci&#243;n</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tama&#241;o limitado de la muestra&#46;</p></span> <span id="abst0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusi&#243;n</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La evoluci&#243;n cronol&#243;gica de las lesiones histopatol&#243;gicas pulmonares asociadas a la COVID-19 parece ser similar a la de otras formas de SDRA&#46; En particular&#44; se observan da&#241;os pulmonares coherentes con las lesiones potencialmente sensibles a los corticosteroides&#46;</p></span>"
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          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Data are <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; or mean &#40;SD&#41; unless otherwise stated&#46; SAPS 2&#44; simplified acute physiological score&#59; CRP&#44; C-reactive protein&#59; PCT&#44; procalcitonin&#59; LDH&#44; lactate dehydrogenase&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">General characteristics of the 22 patients</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#91;63&#8211;73&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#47;22 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Overweight &#40;BMI from 25 to &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;22 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obese &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;22 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 2 diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;22 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#47;22 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Currently smocker patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;22 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;22 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;22 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kidney graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;22 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;22 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SAPS II&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#91;47&#8211;67&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration of mechanical ventilation&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#91;8&#8211;23&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NeuroMuscular Blocking Drugs &#40;NMBD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;22 &#40;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prone position&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;22 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Steroid therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;22 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Veno-venous Extracorporeal Membrane Oxygenation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;22 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory results collected at admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leukocytes&#44; 10<span class="elsevierStyleSup">9</span>&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#91;5&#46;6&#8211;14&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphocytes&#44; 10<span class="elsevierStyleSup">9</span>&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#91;0&#46;2&#8211;0&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRP&#44; mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;1 &#91;110&#46;9&#8211;182&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCT&#44; &#956;g&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2 &#91;0&#46;48&#8211;3&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">511&#46;5 &#91;449&#46;2&#8211;562&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial lactate&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4 &#91;1&#8211;2&#46;3&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D-dimeres&#44; &#956;g&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2320 &#91;980&#8211;4050&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventilatory parameters collected at admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;6 &#91;0&#46;5&#8211;0&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#91;10&#8211;14&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pplat&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5 &#91;22&#8211;26&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Driving pressure&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#91;9&#8211;14&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;5 &#91;120&#46;2&#8211;182&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventilatory parameters collected at time of death</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#91;0&#46;45&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#91;5&#8211;10&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pplat&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#91;26&#8211;31&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Driving pressure&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#91;16&#8211;24&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 &#91;71&#8211;217&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#91;15&#8211;24&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fibrosis &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No fibrosis &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#91;64&#46;5&#8211;73&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#91;58&#8211;71&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SAPS II&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#91;43&#46;7&#8211;61&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#91;54&#46;7&#8211;69&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration of mechanical ventilation&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#91;20&#8211;29&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#91;5&#46;75&#8211;11&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Steroid therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Delay between the onset of ventilation and start of steroids&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;4&#8211;15&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#91;2&#8211;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventilatory parameters collected at time of death</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97 &#91;0&#46;42&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#91;0&#46;5&#8211;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEEP&#44; mean cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6 &#91;5&#8211;7&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;5&#8211;10&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 &#91;72&#8211;219&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">114 &#91;76&#8211;191&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19 &#91;14&#8211;23&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#91;18&#8211;24&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Steroids &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No Steroids &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Near-normal lung architecture&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudative phase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">36&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">63&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Proliferative&#47;organizing phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrosis phase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute fibrinous and organizing pneumonia &#40;AFOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VAP &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No VAP &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Near-normal lung architecture&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudative phase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Proliferative&#47;organizing phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrosis phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute fibrinous and organizing pneumonia &#40;AFOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">69&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Histologic features of 22 patients who developed a ventilator-associated pneumonia &#40;VAP&#41; and those who did not&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#91;41&#46;5&#8211;62&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#91;4&#46;5&#8211;14&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11 &#91;2&#8211;14&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6 &#91;4&#8211;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dynamic compliance&#44; ml&#47;cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan&#44; China"
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        "texto" => "<p id="par0230" class="elsevierStylePara elsevierViewall">We thank Nathalie BERVAS and Karine LEMARCHAND &#40;Tetu Bio&#41; for the SARS-CoV antibody&#46; We are also grateful to Martine MUCKENSTURM&#44; Catherine LEBERQUIER&#44; Florence GUENARD and Tuy-Tien TONG for technical assistance&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The authors thank Ms&#46; H&#46; GOETZ for her English proofreading of the manuscript&#46;</p>"
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