ABSTRACT
Introduction: Lung cavitation is a rare radiological finding of COVID- 19 pneumonia associated with unfavorable outcome. Its pathogenesis is unclear and it is characterized by diffuse alveolar damage, intra-alveolar hemorrhage and necrosis of parenchymal cells. Method(s): We retrospectively reviewed the radiological findings of COVID-19 patients admitted to our ICU during the pandemic in order to identify the development of lung cavitary lesions. Result(s): From 11/2020 until 10/2022 1000 patients were admitted to our COVID-19 ICU (92% on invasive mechanical ventilation). According to our data there were three cases of lung cavity formation. The first case was a 78 years male with history of hypertension. Chest CT (Day26) showed a 11.6 cm cavity in the right middle lobe (Fig. 1). The second case was a 52 year old female with history of diabetes mellitus, obesity, hypertension and rheumatoid arthritis. Follow up chest CT (D29) revealed progressive development of multiple bilateral cavitary lesions. The third case was a 61 year old male with no medical history, who developed (D17) multiple cavitary lesions in both lower lobes, concomitant with left-sided pulmonary embolism. The presence of other well defined etiologies of cavitary lesions such as mycobacterial and fungal infections as well as neoplasmatic or autoimmune diseases had been widely excluded. However, since pulmonary cavitation is a late complication of severe COVID disease, we cannot overlook the fact that all patients suffered from superinfections by XDR Acinetobacter baumanii and/or Klebsiella pneumonia, as most of our patients with prolonged length of stay. Moreover, two of the three patients developed pneumothorax. All patients finally died. Conclusion(s): Although bacterial co-infection does not allow absolute association between cavitary formation and coronavirus disease, it seems that destructive triggers, such as bacteria or mechanical ventilation, may aggravate COVID underlying lung lesions leading to cavitation.
ABSTRACT
Introduction: APACHE II severity scoring system has been successfully used for mortality risk assessment in the ICU, however its validity in the subgroup of COVID-19 patients has been questionable. We aimed to examine the predictive value of APACHE II score in a cohort of critically ill COVID-19 patients. Method(s): We performed a retrospective analysis of prospectively collected data in a cohort of COVID-19 patients admitted to our 50-bed ICU between October 2020 and April 2022. Using a ROC analysis we assessed the performance of APACHE II score and identified the optimal cut-off value for mortality prediction. Result(s): Our cohort included 783 patients (66% male) with positive PCR forSARS-Cov-2 and respiratory failure. Mean age was 66 years. Invasive mechanical ventilation was used in 92%of patients and 89.3% had at least one comorbidity. The mean APACHE II score of the whole cohort was 20.3 (+/- 8.5). ICU mortality was 44.7%. Death rate was similar between sexes but significantly higher in those who were older and those suffering from COPD, chronic renal or heart failure, atrial fibrillation or any kind of malignancy. Non-survivors had a significantly higher APACHE II score compared to survivors (25.2 +/- 7.9 vs 16.3 +/- 6.7, p < 0.001). ROC analysis showed an AUC 0.81 (95% CI 0.78-0.84, p < 0.001). At a cut-off value of 19.5 APACHE II score could predict death with a sensitivity of 77.1% (95% CI 72.4-81.4%), a specificity of 70.7% (95% CI 66.1-74.9%), PPV 68% (95% CI 63.2-72.6%) and NPV 79.3% (95% CI 74.9-83.2%). Conclusion(s): APACHE II score is an effective tool for mortality prediction in critically ill COVID-19 patients. A cut-off value of 19.5 can be used for risk stratification in this patient population.
ABSTRACT
The following sentence of the paper has been removed: Cockpit boredom and alertness levels of pilots have long perplexed the literature [38] until recently in the COVID-19 crisis [39]. References 38 and 39 have been removed. References 40 through 48 have therefore been renumbered. © 2021 SAE International.