Relation of high resolution pulmonary CT findings and clinical condition of COVID-19 patients.

INTRODUCTION: At present, chest computed tomography (CT) is accepted as a tool for assessment COVID-19 patients. However, there are few data about the relationship between initial imaging results at presentation and the presence of systemic inflamma-tory mediators and outcome in patients with COVID-19. The aim of study is to evaluate the relation of initial high resolution com-puted tomography (HRCT) chest findings to inflammatory indices and clinical course of COVID-19 patients during hospitalization. MATERIAL AND METHODS: This is a retrospective cohort study carried out on 108 confirmed COVID-19 patients. Demographic, lab-oratory and radiological data were recorded from patients medical records. Based on predominant HRCT density, patients were classified into either normal, ground glass opacity (GGO) and consolidation groups. By HRCT score, patients were classified into either no infilteration, ≤ 50% infilteration and > 50% infilteration groups. Comparison between clinical and laboratory parameters were observed among the groups. RESULTS: More hypoxemia, higher inflammatory indices (CRP, d-dimer, ferritin), more requirement of ventilatory support and more mortality rate were observed in consolidation group compared to GGO (p < 0.05) and in patients with HRCT score > 50% compared to ≤ 50% infilteration group (p < 0.05). CONCLUSIONS: Consolidation pattern and high CT chest quantitative score are associated with elevated inflammatory indices and poor outcome in COVID-19 patients. HRCT chest can be used for risk stratification of COVID-19 patients.

Clinical characteristics and outcomes of post-COVID-19 pulmonary fibrosis: A case-control study.

ABSTRACT: The development of pulmonary fibrosis is a rare complication of the novel coronavirus disease 2019 (COVID-19). Limited information is available in the literature about that, and the present study aimed to address this gap.This case-control study included 64 patients with post-COVID-19 pulmonary fibrosis who were hospitalized for COVID-19.The percentage of patients aged ≥65 years (44%) who demised was higher than those who survived (25%). Male patients (62%) had higher mortality than female patients (37%). The most frequently reported clinical symptoms were shortness of breath (98%), cough (91%), and fever (70%). Most COVID-19 patients with pulmonary fibrosis (81%) were admitted to an intensive care unit (ICU), and 63% required mechanical ventilation. Bilateral lung infiltrates (94%), "ground glass" opacity (91%), "honeycomb" lung (25%), and pulmonary consolidation (9%) were commonly identified in COVID-19 patients with pulmonary fibrosis who survived. The findings for computed tomography and dyspnea scale were significantly higher in severe cases admitted to the ICU who required mechanical ventilation. A higher computerized tomography score also correlated significantly with a longer duration of stay in hospital and a higher degree of dyspnea. Half of the COVID-19 patients with pulmonary fibrosis (50%) who survived required oxygen therapy, and those with "honeycomb" lung required long-term oxygen therapy to a far greater extent than others. Cox regression revealed that smoking and asthma were significantly associated with ICU admission and the risk of mortality.Post-COVID-19 pulmonary fibrosis is a severe complication that leads to permanent lung damage or death.

Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients.

AIM: To evaluate role of diaphragmatic thickening and excursion, assessed ultrasonographically, in predicting extubation outcome. METHODS: Fifty-four patients who successfully passed spontaneous breathing trial (SBT) were enrolled. They were assessed by ultrasound during SBT evaluating diaphragmatic excursion, diaphragmatic thickness (Tdi) at end inspiration, at end expiration and diaphragmatic thickness fraction (DTF%). Simultaneously traditional weaning parameters were recorded. Patients were followed up for 48h after extubation. RESULTS: Out of 54 included patients, 14 (25.9%) failed extubation. Diaphragmatic excursion, Tdi at end inspiration, at end expiration and DTF% were significantly higher in the successful group compared to those who failed extubation (p<0.05). Cutoff values of diaphragmatic measures associated with successful extubation were ≥10.5mm for diaphragmatic excursion, ≥21mm for Tdi at end inspiration, ≥10.5mm for Tdi at end expiration, ≥34.2% for DTF% giving 87.5%, 77.5%, 80% and 90% sensitivity respectively and 71.5%, 86.6%, 50% and 64.3% specificity respectively. Combining diaphragmatic excursion ≥10.5mm and Tdi at end inspiration ≥21mm decreased sensitivity to 64.9% but increased specificity to 100%. Rapid shallow breathing index (RSBI) <105 had 90% sensitivity but 18.7% specificity. CONCLUSION: Ultrasound evaluation of diaphragmatic excursion and thickness at end inspiration could be a good predictor of extubation outcome in patients who passed SBT. It is recommended to consider the use of these parameters with RSBI consequently to improve extubation outcome.

Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness.

BACKGROUND: Cardiovascular dysfunction has been reported as an important mechanism of weaning failure. Brain natriuretic peptide (BNP) is a sensitive and specific marker for cardiovascular dysfunction. OBJECTIVE: To determine the value of BNP levels measured at initiation and end of a 2h spontaneous breathing trial (SBT) as a predictor of successful weaning of mechanical ventilation in patients with respiratory illness. PATIENTS AND METHODS: Thirty consecutive patients ready for weaning were prospectively enrolled in this cross-sectional analytic study over a 6-month period. All patients had been on spontaneous mode of weaning for at least 2h. Tidal volume, respiratory rate, rapid shallow breathing index (RSBI), minute ventilation and PaO2/FiO2 were observed at initiation of SBT. BNP was measured at the initiation (BNP1) and at the end of SBT (BNP2). Weaning failure is defined as either the failure of SBT or the need for reintubation within 48 h following extubation. RESULTS: Out of the 30 included patients, 14 (46.6%) patients had failed weaning. PaCO2 and BNP2 were significantly higher in the patients with failed weaning as compared to those with successful weaning (P = 0.025, P = 0.031 respectively). However, BNP1 levels were not statistically significant between the 2 groups (P = 0.722). On multiple regression analysis, BNP% (percent change in the BNP level during the 2-h SBT) was the only predictor of weaning success. As compared to other weaning parameters, BNP% ≤ 14.9 had the best sensitivity, specificity, positive and negative predictive value. CONCLUSION: Measuring the percentage change in the BNP level during a SBT may be a good predictor of weaning success from mechanical ventilation in respiratory patients.