舒适护理模式在ICU机械通气清醒患者中的应用

目的：通过舒适护理的应用,减轻ICU机械通气患者的不适感。方法：对3年89例入住ICU机械通气患者易出现的症状实施舒适护理。结果：89例在生理、心理、社会及灵魂四个方面得到改善,随访满意率达到96.55%。结论：舒适护理模式在高海拔地区ICU机械通气患者中应用不仅提高ICU护士综合能力,也提高ICU护理服务质量,体现了以患者为中心、人文护理的理念。     

Systematic review and meta-analysis of chest radiograph (CXR) findings in COVID-19

Chest radiography (CXR) is most likely to be the utilized modality for diagnosing COVID-19 and following up on any lung-associated abnormalities. This review provides a meta-analysis of the current literature on CXR imaging findings to determine the most common appearances of lung abnormalities in COVID-19 patients in order to equip medical researchers and healthcare professionals in their efforts to combat this pandemic. Twelve studies met the inclusion criteria and were analyzed. The inclusion criteria consisted of: (1) published in English literature; (2) original research study; (3) sample size of at least 5 patients; (4) reporting clinical characteristics of COVID-19 patients as well as CXR imaging features; and (5) noting the number of patients with each corresponding imaging feature. A total of 1948 patients were included in this study. To perform the meta-analysis, a random-effects model calculated the pooled prevalence and 95% confidence intervals of abnormal CXR imaging findings. Seventy-four percent (74%) (95% CI: 51–92%) of patients with COVID-19 had an abnormal CXR at the initial time of diagnosis or sometime during the disease course. While there was no single feature on CXR that was diagnostic of COVID-19 viral pneumonia, a characteristic set of findings were obvious. The most common abnormalities were consolidation (28%, 95% CI: 8–54%) and ground-glass opacities (29%, 95% CI: 10–53%). The distribution was most frequently bilateral (43%, 95% CI: 27–60%), peripheral (51%, 95% CI: 36–66%), and basal zone (56%, 95% CI: 37–74%) predominant. Contrary to parenchymal abnormalities, pneumothorax (1%, 95% CI: 0–3%) and pleural effusions (6%, 95% CI: 1–16%) were rare.     

Initial chest radiography in the neonatal intensive care unit: value of the lateral view.

This study was designed to assess the diagnostic efficacy of the routine lateral chest film in symptomatic newborn infants. The initial anteroposterior chest film was supplemented by alateral view in 53 consecutive patients on admission to the newborn intensive care unit. Subsequently three radiologists and two neonatologists performed independent analysis of the anterposterior films with and without the lateral view. A total of 530 observations were tabulated. Assessment of degree of lung inflation and discovery of abnormalities of the heart, mediastinum, and trachea were unaffected by the use of the lateral radiograph. A correct primary diagnosis was made in 74% of all cases by the anteroposterior chest film alone and in 71% by the anteroposterior/lateral series. Degree of confidence in the primary diagnosis did not change when the lateral chest radiograph was added. There was no appreciable difference in detection of complicatins of the primary disease in either series. We conclude that the risks (e.g., radiation and environmental disturbance) of the routine admission lateral chest radiograph are substantially greater than any benefits to be gained.     

Effect of mechanical ventilation and positive end-expiratory pressure (PEEP) on chest radiograph.

The effect of differing ventilator settings and positive end-expiratory pressure (PEEP) on the chest radiograph was studied in 12 patients with acute respiratory failure. Changing ventilator settings produced dramatic variations in the appearance of pulmonary infiltrates in technically identical radiographs exposed over a 10-15 min period. PEEP had the greatest effect on radiographic appearance. In seven patients, the diagnosis or estimation of severity of pulmonary infiltrates would have been altered if only the film during PEEP had been available. Knowledge of ventilator settings is vital in evaluating the severity of infiltration and radiographic diagnosis in patients with acute respiratory failure.     

Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals

Emergency Radiology - The COVID-19 pandemic is straining the health care systems worldwide. Therefore, health systems should make strategic shifts to ensure that limited resources provide the...     

Correction to: Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals

Emergency Radiology - A correction to this paper has been published: https://doi.org/10.1007/s10140-021-01943-0     

Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19

ObjectivesCurrent events with the recent COVID-19 outbreak are necessitating steep learning curves for the NHS workforce. Ultrasound, although not used in the diagnosis of COVID-19 may be utilised by practitioners at the point of care (POC) or on the intensive care units (ITUs) where rapid assessment of the lung condition may be required. The aim of this article was to review current literature surrounding the use of lung ultrasound in relation to COVID-19 and provide Sonographers with a quick and digestible reference guide for lung pathologies.Key findingsUltrasound is being used in Italy and China to help review lung condition during the COVID-19 outbreak however not strictly as a diagnostic tool as Computed Tomography (CT) of the chest and chest radiographs are currently gold standard. Ultrasound is highly sensitive in the detection of multiple lung pathologies which can be demonstrated in conjunction with COVID-19 however to date there are no specific, nor pathognomonic findings which relate to COVID-19 on ultrasound.ConclusionLung ultrasound is highly sensitive and can quickly and accurately review lung condition creating potential to assess for changes or resolution over time, especially in the ITU and POC setting. However it should not be used as a diagnostic tool for COVID-19 due to low specificity in relation to the virus.Implications for practiceThe adoption of lung ultrasound to monitor lung condition during the COVID-19 outbreak may reduce the need for serial exposure to ionising radiation on the wards and in turn reduce the number of radiographers required to attend infected wards and bays, protecting both patients and the workforce.     

Novel coronavirus disease 2019 (COVID-19): relationship between chest CT scores and laboratory parameters

European Journal of Nuclear Medicine and Molecular Imaging - To quantify the severity of 2019 novel coronavirus disease (COVID-19) on chest CT and to determine its relationship with laboratory...     

Computer assisted analysis of the chest radiograph lung area and prediction of failure of extubation from mechanical ventilation in preterm neonates

Post-extubation chest radiographs (CXRs) are frequently requested on the neonatal intensive care unit, but it is controversial whether they generate useful information. A low lung volume assessed by measurement of functional residual capacity (FRC) post extubation has been demonstrated to predict extubation failure, which is a subsequent requirement for increased respiratory support. We have previously shown that the CXR lung area obtained by computer assisted analysis significantly correlated with FRC and, therefore, speculated that a low CXR lung area post extubation would reliably predict extubation failure. The aim of this study was to test the hypothesis by analysing CXRs from 20 infants, with median gestational age of 28 weeks (range 25-33 weeks) and postnatal age 4 days (range 1-11 days). CXRs were obtained within 4 h of extubation and were scanned and analysed using a Power Macintosh computer with a Wacom A5 Ultra pad and NIH image software. The cardiac, mediastinal and thymic shadows, and areas of perihilar and lobar consolidation were subtracted from the thoracic area to give the lung area. Seven infants failed extubation and differed significantly from the rest of the cohort only with regard to their CXR lung area, median gestational age, birth weight and postnatal age. Receiver operator characteristic (ROC) curves were constructed and the areas under each ROC curve were compared. Analysis demonstrated that a low CXR lung area and an older postnatal age were the best predictors of extubation failure. A post-extubation CXR lung area of < 8.5 cm2 had the highest specificity (100%) in predicting extubation failure. We conclude that routine post-extubation CXRs can have a useful role.     

Quantitative assessment of lung involvement on chest CT at admission: Impact on hypoxia and outcome in COVID-19 patients

BackgroundThe aim of this study was to quantify COVID-19 pneumonia features using CT performed at time of admission to emergency department in order to predict patients' hypoxia during the hospitalization and outcome.MethodsConsecutive chest CT performed in the emergency department between March 1st and April 7th 2020 for COVID-19 pneumonia were analyzed. The three features of pneumonia (GGO, semi-consolidation and consolidation) and the percentage of well-aerated lung were quantified using a HU threshold based software. ROC curves identified the optimal cut-off values of CT parameters to predict hypoxia worsening and hospital discharge. Multiple Cox proportional hazards regression was used to analyze the capability of CT quantitative features, demographic and clinical variables to predict the time to hospital discharge.ResultsSeventy-seven patients (median age 56-years-old, 51 men) with COVID-19 pneumonia at CT were enrolled. The quantitative features of COVID-19 pneumonia were not associated to age, sex and time-from-symptoms onset, whereas higher number of comorbidities was correlated to lower well-aerated parenchyma ratio (rho = −0.234, p = 0.04) and increased semi-consolidation ratio (rho = −0.303, p = 0.008).Well-aerated lung (≤57%), semi-consolidation (≥17%) and consolidation (≥9%) predicted worst hypoxemia during hospitalization, with moderate areas under curves (AUC 0.76, 0.75, 0.77, respectively). Multiple Cox regression identified younger age (p < 0.01), female sex (p < 0.001), longer time-from-symptoms onset (p = 0.049), semi-consolidation ≤17% (p < 0.01) and consolidation ≤13% (p = 0.03) as independent predictors of shorter time to hospital discharge.ConclusionQuantification of pneumonia features on admitting chest CT predicted hypoxia worsening during hospitalization and time to hospital discharge in COVID-19 patients.     

COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications

Emergency Radiology - The first cluster of cases of COVID-19 pneumonia was reported on December 31, 2019. Since then, this disease has spread rapidly across the world, and as of September 17, 2021,...     

Prognostic findings for ICU admission in patients with COVID-19 pneumonia: baseline and follow-up chest CT and the added value of artificial intelligence

Emergency Radiology - Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18&nbsp;months. Coronavirus disease 19 (COVID-19) causes...     

Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology

The purpose of this study is to assess the utility of the chest high-resolution computed tomography (HRCT) scan for estimating the severity of haemoptysis, localize the bleeding site and to determine a cause of the bleeding. We reviewed 80 consecutive patients who were admitted to a respiratory intensive care unit (RICU) for haemoptysis and who underwent unenhanced HRCT scanning and fibre-optic bronchoscopy (FOB) within 48 h. The number and type of lobar involvement on the CT scan were correlated to prognostic factors, the amount of bleeding and the bleeding aetiology. We compared HRCT scan observations on localization and bleeding aetiology with FOB results. The number of involved lobes was correlated with the daily (p<0.001) and cumulative (p<0.001) volume of haemoptysis and found to be significantly greater in the group of patients who were mechanically ventilated and/or died (2.7 vs 1.8, p<0.03). FOB and HRCT localized the bleeding site or side, respectively, in 71 (89%) and 64 (80%) patients (p>0.05). Of the nine patients without FOB localization, HRCT localized the bleeding site in six patients (67%). The initial HRCT scan correctly identified 48 aetiologies (60%), whereas FOB identified only 2 proximal bronchogenic carcinomas. The extent of lobar involvement seen by HRCT is a prognostic factor correlated with the daily and cumulative volume of haemoptysis. FOB and HRCT are complementary techniques for bleeding site localization. HRCT-scan is also the best exam to determine the cause of haemoptysis, even while it is occurring.     

Target-shaped combined halo and reversed-halo sign,an atypical chest CT finding in COVID-19

Typical chest CT findings in COVID-19 have been described as bilateral peripheral ground glass opacities, with or without consolidation. Halo sign and reversed halo sign have been reported as atypical imaging findings in this disease. However, to the best of our knowledge, combined presence of these signs has never been reported before. Herein, we present a COVID-19 patient with numerous atypical target-shaped, combined halo and reversed halo pulmonary lesions, in the absence of any other underlying disease.     

Diagnostic accuracy and inter-observer agreement with the CO-RADS lexicon for CT chest reporting in COVID-19

Emergency Radiology - To measure the diagnostic accuracy and inter-observer agreement with the use of COVID-19 Reporting and Data System (CO-RADS) for detection of COVID-19 on CT chest imaging....