![]() In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift from oedema or atelectasis to less reversible structural lung alterations to lung fibrosis. Otherwise, mechanical ventilation should be considered to avert P-SILI. Noninvasive supports are indicated if they result in a reversal of hypoxaemia and a decreased inspiratory effort. Oedema and atelectasis may develop, increasing recruitability. In the high-dependency unit: the disease starts to worsen either because of its natural evolution or additional patient self-inflicted lung injury (P-SILI). The anatomical prerequisites for PEEP (positive end-expiratory pressure) to work (lung oedema, atelectasis, and therefore recruitability) are lacking. The underlying mechanism is primarily altered lung perfusion. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. ![]()
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