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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-05042022-121356
Document
Author
Full name
Sckarlet Ernandes Biancolin Garavazzo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Brizot, Maria de Lourdes (President)
Francisco, Rossana Pulcineli Vieira
Nomura, Marcelo Luis
Sawamura, Márcio Valente Yamada
Title in Portuguese
Ultrassom pulmonar vs. tomografia computadorizada de tórax em gestantes internadas com COVID-19
Keywords in Portuguese
COVID-19: SARS-CoV-2
Gravidez
Síndrome respiratória aguda grave
Tomografia computadorizada de tórax
Ultrassom pulmonar
Abstract in Portuguese
OBJETIVO: Comparar a ultrassonografia pulmonar (USG) e a tomografia de tórax (TC) a partir de alterações pulmonares identificadas em gestantes internadas por infecção pelo SARS-CoV-2. MÉTODO: Estudo prospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de junho a setembro do ano de 2020. Foram incluídas 39 gestantes internadas com COVID-19 submetidas à avaliação pulmonar por meio da TC e da USG, com intervalo máximo de 48 horas entre os exames. O tórax foi dividido em 6 regiões por hemitórax (2 anteriores, 2 laterais e 2 posteriores). A USG avaliou a presença das linhas B > 2, linhas B coalescentes e consolidação, e a TC, a presença do espessamento interlobular, vidro fosco e consolidação. A pontuação (escore) foi atribuída mediante o pior achado alterado por quadrante e o derrame pleural foi avaliado. As gestantes foram divididas em dois grupos conforme a necessidade do uso de oxigênio (O2) suplementar. Os exames de imagem foram comparados de acordo com os achados alterados por quadrante e segundo o escore pulmonar. Também foi realizada a avaliação do desempenho de cada método na predição da necessidade do uso de O2 suplementar. RESULTADOS: Verificou-se uma correlação significativa entre os escores obtidos pelos dois métodos (rICC = 0,946; p<0.001). A comparação da frequência de quadrantes alterados entre a USG e a TC mostrou uma concordância moderada (Kappa ponderado = 0,551). Para a USG, o escore pulmonar >15, linhas B coalescentes e presença de consolidação foram preditoras da necessidade do uso de O2 suplementar. Já a TC teve como preditores o escore pulmonar >16 e a consolidação. CONCLUSÃO: Há correlação significativa entre os escores obtidos pela USG e pela TC em gestantes internadas com COVID-19. A USG teve desempenho tão satisfatório quanto a TC na avaliação do escore pulmonar levando em conta a necessidade do uso de O2
Title in English
Lung ultrasound vs. chest computed tomography for pregnant inpatients with COVID-19
Keywords in English
Chest computed tomography
COVID-19: SARS-CoV-2
Lung ultrasound
Pregnancy
Severe acute respiratory syndrome
Abstract in English
OBJECTIVE: The aim of this study was to compare to compare lung ultrasound (LUS) and computed tomography (CT) in the assessment of pregnant women with COVID-19. METHOD: This study was conducted at Hospital das Clinicas, Sao Paulo University, from June to September 2020 and this is a prospective study comprising 39 pregnant inpatients with COVID-19 who underwent pulmonary assessment with CT and US with a maximum span of 48 hours between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B-lines (> 2), coalescent B-lines, consolidation, and pleural effusion on LUS; presence of interlobular thickening, ground glass, consolidation, and pleural effusion on CT. The two methods were scored by adding up the scores from each thoracic region. Pregnant women were separated into two groups according to the need for oxygen (O2). Performance analyses and accuracy of prediction were done about severity disease. RESULTS: A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p<0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In LUS, a score over 15, coalescent B-lines, and consolidation were predictors of the need for O2, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US (p<0.001) and CT (p<0.001), were fairly accurate in predicting the need for oxygen (O2) (AUC= 0.915 and 0.938 respectively). CONCLUSION: In pregnant women, lung US and CT of the chest are of similar accuracy in assessing lungs affected by COVID-19 and can predict the need for O2
 
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Publishing Date
2022-04-07
 
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