scholarly journals A pragmatic approach and treatment of coronavirus disease 2019 (COVID-19) in intensive care unit

2020 ◽  
Vol 66 (8) ◽  
pp. 1157-1163
Author(s):  
Sergio Henrique Loss ◽  
Diego Leite Nunes ◽  
Oellen Stuani Franzosi ◽  
Cassiano Teixeira

SUMMARY There is a new global pandemic that emerged in China in 2019 that is threatening different populations with severe acute respiratory failure. The disease has enormous potential for transmissibility and requires drastic governmental measures, guided by social distancing and the use of protective devices (gloves, masks, and facial shields). Once the need for admission to the ICU is characterized, a set of essentially supportive therapies are adopted in order to offer multi-organic support and allow time for healing. Typically, patients who require ventilatory support have bilateral infiltrates in the chest X-ray and chest computed tomography showing ground-glass pulmonary opacities and subsegmental consolidations. Invasive ventilatory support should not be postponed in a scenario of intense ventilatory distress. The treatment is, in essence, supportive.

Author(s):  
Akın Çinkooğlu ◽  
Selen Bayraktaroğlu ◽  
Naim Ceylan ◽  
Recep Savaş

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.


2008 ◽  
Vol 109 (5) ◽  
pp. 864-871 ◽  
Author(s):  
Marc Leone ◽  
Fabienne Brégeon ◽  
François Antonini ◽  
Kathia Chaumoître ◽  
Aude Charvet ◽  
...  

Background Currently, there are limited data available describing the long-term outcomes of chest trauma survivors. Here, the authors sought to describe chest trauma survivor outcomes 6 months and 1 yr after discharge from the intensive care unit, paying special attention to pulmonary outcomes. Methods A cohort of 105 multiple trauma patients with blunt chest trauma admitted to the intensive care unit was longitudinally evaluated. After 6 months, a chest computed tomography scan, pulmonary function testing (PFT), and quality of life were collected in 55 of these patients. A subgroup of 38 patients was followed up for 1 yr. Results At least one abnormal PFT result was found in 39 patients (71%). Compared with normalized data of the age- and sex-matched population, physical function was decreased in 38 patients (70%). The 6-min walk distance was reduced for 29 patients (72%). Although pathologic images were observed on the chest computed tomography scan from 33 patients (60%), no relation was found between PFT and computed tomography. A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to the intensive care unit predicted an abnormal PFT result at 6 months. One year after discharge from the intensive care unit, paired comparisons showed a significant increase in forced vital capacity (P = 0.02) and Karnofsky Performance Status (P &lt; 0.001). Conclusions Survivors of multiple traumas including chest trauma demonstrate a persistent decrease in the 6-min walk distance, impairment on PFT, and reduced pulmonary-specific quality of life.


ESC CardioMed ◽  
2018 ◽  
pp. 1582-1584
Author(s):  
Angelos G. Rigopoulos ◽  
Hubert Seggewiss

Pericardial masses include cysts, pericardial tumours, and pericardial haematomas. Pericardial cysts are benign lesions commonly located in the right cardiophrenic angle that remain typically asymptomatic and are incidentally found in chest X-ray or chest computed tomography but might cause pressure symptoms or become infected, thus requiring surgical management. Hydatid cysts due to echinococcosis are the most common acquired pericardial cysts, characterized by wall calcification, and indicate surgery.


2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Mohammad Ashkan Moslehi ◽  
Mohammad Hadi Imanieh ◽  
Ali Adib

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the rightB7-8bronchus and removed by forceps and a Dormia basket.


2017 ◽  
Vol 214 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Shelby Resnick ◽  
Kenji Inaba ◽  
Efstathios Karamanos ◽  
Dimitra Skiada ◽  
James A. Dollahite ◽  
...  

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