The charateristics of patients with pulmonary post covid fibrosis

Aims of the study: to identify The charateristics of patients with pulmonary post covid fibrosis Methods: This was a prospective study conducted betwwen january and june 2021. All patients admitted in our hospital and diagnosed with COVID 19 disease were followed up at 3 months after discharge. We compared clinical, biological and ventilator characteristics of two groups : G1 with post covid pulmonary fibrosis and G2 without post covid pulmonary fibrosis Results: Eighty-seven COVID-19 survivors who had undergone a follow-up CT scans after 3 months of discharge from hospital were G1(n=20) and G2 (n=67). Compared to G2,G1 patients were older (p<0.001) without gender predominance ;they had significantly lower oxygen saturation at 3 months of follow up with a median of 96,5 (94,2- 98) vs 98(97-98) p=0.001 . On the biological level the median of CRP in G1 was higher than G2, 15(5-23) vs 2(0-4) p=0,001 and the median of lymphocytes was lower in the group with fibrosis 1100 (970-1600) vs 2095 (1721-2685). The majority of patients had a restrictive ventilatory disorder with no significant difference between the two groups . Conclusion(s): Post-COVID-19 pulmonary fibrosis is a severe complication that leads to permanent lung damage or death. Early detection may help to prevent or at least delay its development. Thus the interest to recognize the profil of fibrotic patients.

Pneumomediastinum in COVID-19 critically ill patients

Pneumomediastinum in COVID-19 critically ill patients Introduction: Pneumomedisatinum(PM) is an uncommon potentially life-threatening complication of COVID-19 and can be an aggravating factor. This study aimed to determine the incidence and outcomes of PM in critically ill COVI19 patients. Method(s): A retrospective study carried out in a 9-bed intensive care unit from October 1st, 2020 to February 28, 2021 including patients with confirmed COVID19 related acute respiratory distress syndrome (ARDS) with confirmed PM on Chest computed tomography (CT). Were recorded patients characteristics, management and outcomes. Result(s): 7 cases of PM were reported : 5 men, 2 women, aged between 47 and 70 years-old. None of them had underlying lung disease. 4 patients were under invasive mechanical ventilation (IMV), 2 under non-invasive ventilation (NIV) and one had a spontaneous PM at the time of the event. Chest CT scan showed : pulmonary involvement, moderate (n=4/7) to severe (n=3/7), PM (n=7/7), subcutaneous emphysema (n=5/7) and pneumothorax (n=2/7). The highest positive end-expiratory pressure (PEEP) for patients receiving IMV and NIV were respectively 10cmH2O and 6cmH2O. Urgent mediastinal decompression wasn't immediately indicated, conservative therapy with reduced airway pressure was adopted. Patients with NIV were intubated after NIV failure. Despite protective ventilation with lower pressure, needle aspiration and chest drainage, all patients expired during their hospital stay. Conclusion(s): Our findings suggest that PM is secondary to inflammatory response due to COVID-19 and mostly triggered by the use of positive pressure ventilation and it is associated with poor outcome in critically ill COVID-19 patients.

Chest CT scan lesions as predictors of poor prognosis in critically ill COVID-19 patients

Chest CT scan lesions as predictors of poor prognosis in critically ill COVID-19 patients Background: Chest computed tomography (CT) scan was suggested to be an early tool for the diagnosis of COVID19 pneumonia. However, little is known about the role of chest CT-scan to predict outcomes in patients admitted in intensive care unit (ICU) for COVID-19 pneumonia. Aim(s): To determine the association between the extent of chest CT scan lesions and poor outcomes in critically ill COVID-19 patients. Method(s): A retrospective observational study performed in a 9-bed ICU from 1rst January 2021 to December 31, 2021 including adult admitted for COVID-19 pneumonia who underwent a chest CT scan. Patients' charaterisics, chest CT findings, management and outcomes were collected. Result(s): During the study period, 146 patients underwent a chest CT scan. Patients' characteristics were: mean age 50.62+/-14.95years, median SAPSII, 24[16-31];median SOFA, 3[2-4] and median PaO2/FiO2 ratio 92[69-123]. High flow nasal cannula was performed in 128(87.7%) and 12(8.2%) patients required invasive mechanical ventilation (IMV) at admission. Median ICU length of stay was 8[5-14] days, mortality rate was at 55(37.7%) and the 4C mortality score was 1[0-1]. Severe lesions were identified in 89(61%) patients. Prolonged ICU stay was significantly more common in patients with severe lesions (p=0.02). However, mortality rate and IMV use (p=0.746) did not differ between mild to moderate lesion group and severe lesion group (p=0.869). Conclusion(s): Prolonged ICU stay was significantly associated with severe chest CT scan lesions and interestingly, mortality did not differ between severe lesions and mild to moderate lesions.

Can initial Chest CT scan findings predict high flow nasal cannula (HFNC)failure in critically ill COVID19 patients

Can initial Chest CT scan findings predict high flow nasal cannula (HFNC) failure in critically ill COVID19 patients Backgroud: Chest computed tomography (CT) scan is an important tool for the diagnosis of COVID-19 pneumonia and a predictor of clinical outcomes, but few is known about its ability to predict HFNC failure. Aim(s): To investigate the association of initial chest CT scan findings with HFNC failure in critically COVID-19 Methods: A retrospective study performed in a 9-bed ICU from 1rst January 2021 to December 31, 2021 including patients admitted for COVID-19 pneumonia who underwent chest CT scan and treated with HFNC. Patients' characteristics, chest CT findings, and HFNC outcomes were collected Results: Among 146 patients admitted, 128(87.7%) received HFNC. Patients were male in 75(58.6%) with mean age 51.05+/-14.8years, median PaO2/FiO2 ratio 92.75[69-118.5]. HFNC failed in 43(33.6%) patients. Scan findings were: frosted glass images in 118(92.2%), condensations in 60(46.9%) and crazy paving in 16(12.5%)cases. The lesions were : bilateral in 95(74.2%), peripheral in 41(32%) and mixed in 42(32.8%) patients. The extent of scan lesions was severe in 81(63.3%)patients. Univariate analysis identified factors for HFNC failure: bilateral lesions (68(80%) vs 27(62.8%), p=0.044);condensations (35(41.2%) vs 25(58.13%), p=0.049) and mixed lesions (34(40%) vs 8(18.6%), p=0.012). In multivariate analysis, condensations (OR,3.12;95% CI,[1.26-7.68];p=0.013) and mixed lesions (OR, 0.29;95% CI, [0.11-0.76];p=0.012) were the factors associated with HNFC failure Conclusion(s): In this study, condensations and mixed lesions were independently associated factors with HFNC failure.

Facteurs de risque associes a la fibrose pulmonaire post-COVID

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