PŘEHLEDOVÉ ČLÁNKY / REVIEW ARTICLES Imaging of COVID-19 in critical care with a focus on chest ultrasound | 63 / Anest intenziv Med. 2023;34(2):61-68 / ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA www.aimjournal.cz Furthermore, two CUS phenotypes in COVID-19 pneumonia have been proposed: 1) An L phenotype indicating preserved pulmonary compliance correlating with ground‑glass opacities located in the periphery on CT and, 2) An H phenotype indicating significantly reduced pulmonary compliance seen in severe ARDS and with a correlating picture of CT consolidations [5, 22–24]. A severe COVID-19 infection is fraught with bacterial, viral, and fungal superinfections in up to 29% of patients on admission. Many patients suffered from COVID-19 associated multidrug‑resistant bacterial infections, fungal (Aspergillus) infections, pneumocystis, and viral infections and reactivations (CMV, HSV) during their ICU stay [25–27]. These numbers have risen particularly in the first half of 2021 and were associated with increased ICU and hospital mortalities worldwide [28]. CT scanning has been utilised worldwide since the beginning of the pandemic. At this stage with limited access to high quality bedside antigen tests specific for viral load and with a sensitivity above 93% [29], imaging played an important role in the triage of patients. The potential of CT as a triage tool has already been demonstrated in the first datasets Fig. 2. Early stage of severe COVID-19 on CUS and echocardiography, the patient is after intubation due to hypoxaemic respiratory insufficiency. CXR on admission and 24 hrs later depicts delayed progression on radiographic methods: A apical CUS with multiple B3-4 lines, B basal CUS with coalescent B lines, C apical four-chamber view with dilated right ventricle and severe tricuspid regurgitation, D trans-tricuspid CW Doppler gradient of 60 mm Hg in a patient with absent cardiac history, E CXR at the time of CUS and echocardiography showing CXR changes disproportionate to disease severity, F CXR after 24 hrs showing severe ARDS; note the bioimpedance belt across the chest. Pulmonary embolism was excluded by a CTAG prior to admission Fig. 3. Progression of COVID-19 infection on CT during 72 hrs in a patient with hypoxaemic respiratory failure. Images reproduced with permission from the archives of the Department of Diagnostic Radiology, University Hospital Bulovka, Prague, Czech Republic
RkJQdWJsaXNoZXIy NDA4Mjc=