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1.
Chest ; 159(6): 2505-2506, 2021 06.
Article in English | MEDLINE | ID: covidwho-1517091
2.
Chest ; 160(2): 652-670, 2021 08.
Article in English | MEDLINE | ID: covidwho-1491830

ABSTRACT

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.


Subject(s)
COVID-19/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed , COVID-19/complications , COVID-19/therapy , Humans , Prognosis , Sensitivity and Specificity
3.
Chest ; 160(2): 652-670, 2021 08.
Article in English | MEDLINE | ID: covidwho-1220803

ABSTRACT

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.


Subject(s)
COVID-19/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed , COVID-19/complications , COVID-19/therapy , Humans , Prognosis , Sensitivity and Specificity
6.
Chest ; 158(5): 1992-2002, 2020 11.
Article in English | MEDLINE | ID: covidwho-891960

ABSTRACT

The coronavirus disease 2019 pandemic will be remembered for the rapidity with which it spread, the morbidity and mortality associated with it, and the paucity of evidence-based management guidelines. One of the major concerns of hospitals was to limit spread of infection to health-care workers. Because the virus is spread mainly by respiratory droplets and aerosolized particles, procedures that may potentially disperse viral particles, the so-called "aerosol-generating procedures" were avoided whenever possible. Included in this category were noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and awake (nonintubated) proning. Accordingly, at many health-care facilities, patients who had increasing oxygen requirements were emergently intubated and mechanically ventilated to avoid exposure to aerosol-generating procedures. With experience, physicians realized that mortality of invasively ventilated patients was high and it was not easy to extubate many of these patients. This raised the concern that HFNC and NIV were being underutilized to avoid intubation and to facilitate extubation. In this article, we attempt to separate fact from fiction and perception from reality pertaining to the aerosol dispersion with NIV, HFNC, and awake proning. We describe precautions that hospitals and health-care providers must take to mitigate risks with these devices. Finally, we take a practical approach in describing how we use the three techniques, including the common indications, contraindications, and practical aspects of application.


Subject(s)
Cannula , Coronavirus Infections/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Noninvasive Ventilation/methods , Oxygen Inhalation Therapy/methods , Patient Positioning/methods , Pneumonia, Viral/therapy , Prone Position , Respiratory Insufficiency/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Humans , Intubation, Intratracheal , Pandemics , Pneumonia, Viral/transmission , Respiration, Artificial , SARS-CoV-2 , Wakefulness
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