ABSTRACT
Background: During COVID-19 pneumonia management, CT scan is highly contributive. It represents the gold standard examination for both positive and severity diagnosis. Objective(s): We aimed to compare 2 methods of evaluation of CT scan involvement. Method(s): We conducted a prospective cohort study in the ICU of Abderrahmen Mami hospital between January and December 2021. We included critically-ill patients COVID-19 who had a CT scan. We considered two ways to evaluate severity of lung damage: 1/Percentage of lung damage extent (< 50%, 50 to 75% and >= 75%), 2/ CT score (assimilated to Lung Ultrasound Score): Subdivision of each hemithorax into 6 regions: antero-superior and inferior, latero-superior and inferior, postero-superior and inferior. A score was attributed according to the patterns: 0 if normal parenchyma, 1 if few ground-glass lesions, 2 if extensive ground-glass lesions, and 3 if condensations. CT score was the sum of the scores of the 12 regions, thus varying between 0 and 36 Results: We included 158 patients with mean age of 56 +/- 13 years and gender ratio of 1.6. Mean values of SAPS II and APACHE II were respectively 25.4+/-7.7 and 8.7+/-5. Mean initial PaO2/FiO2 was 127.4 +/- 59.7mmHg and ARDS was diagnosed in 153 (98%) patients. The CT extent was distributed as <50 % (27.3 %), [50% - 75 %] (37.8 %) and > 75 % (34.9 %). Mean CT score was 19.4+/-5.8 [5 - 34]. The comparison of the 2 methods, showed a statistically significant result between the CT score and a damage < 50% (p = 0.002), and also between CT score and a damage >= 75% (p = 0.003). Conclusion(s): In COVID-19 pneumonia, lung damage extent seems to be appreciated with percentages as well as CT score. An external validity is mandatory for CT-scan score.
ABSTRACT
Objective: Anti COVID vaccines are efficient in preventing most severe forms of SARS-COV-2 infections. Nevertheless, many vaccinated patients are still at risk to have severe forms. We aimed to describe characteristics, severity and outcome of COVID-19 vaccinated patients admitted in ICU. Method(s): A prospective study conducted between August 15th 2021 and February 20th 2022 in the ICU of Abderrahmen Mami hospital in Tunisia. Patients who received at least one dose of vaccine were included. Epidemiological characteristics, ventilation strategy and vaccine data were collected. Result(s): During the study period, 133 patients were admitted to the ICU, from whom 36 (27%) met the inclusion criteria. All of them received the first dose of the vaccine, 27 (75%) were fully vaccinated (2 doses);only 2 of them have received a booster dose (3rd dose). The majority of vaccinated patients were male (gender-ratio 2.3), mean age was 64 years. Thirty-one patients (86%) had at least one comorbidity. Reason for ICU admission was acute respiratory failure (n = 26;72%) with high O2 needs or complications related to comorbidities (n = 10;28 %). The mean P/F ratio at admission was 160 mmHg. Ventilatory requirement was: high flow nasal canula (22%), non- invasive ventilation (69.4%) and invasive ventilation (33%). ICU mortality among fully vaccinated patients (2 or 3 doses) was 55% (15/27). The most common cause of death was severe hypoxemia and/or a related complication. Only 5 patients died due to complications of their comorbidities. Conclusion(s): Vaccinated patients admitted in ICU were elderly and had comorbidities. ICU mortality among fully vaccinated remains high.
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022
ABSTRACT
Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2020