ABSTRACT
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.
ABSTRACT
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.