Early chest computed tomography in adult acute severe community-acquired pneumonia patients treated in the intensive care unit.
BACKGROUND
The value of early chest computed tomography (CT) was evaluated among severe community-acquired pneumonia (SCAP) patients.


METHODS
The study population consisted of 65 of 457 SCAP patients with concomitant chest CT and radiograph performed within 48 h of ICU admission. Each image pair was re-evaluated by two radiologists. The type of pneumonia, the presence of pleural fluid and atelectasis were assessed. Therapeutic and diagnostic procedures induced by CT results were analysed together with clinical, microbiological and outcome data.


RESULTS
Alveolar pneumonia was observed in 72.3% of patients by radiograph and in 75.4% of patients by CT. Pleural fluid was detected via chest radiograph and CT in 17 (26.2%) and 41 cases (63.1%), (P < 0.001) and atelectasis in 10 (15.4%) and 22 cases (33.8%), (P = 0.002), respectively. In 34 patients (52.3%), the CT revealed 38 new findings (58.5%) not shown in plain chest radiograph. Out of these 34 patients, therapeutic interventions or procedures were performed in 26 (76.5%). The number of infected lobes correlated negatively with the lowest PaO2 /FiO2 ratio (ρ = -0.326, P = 0.008) for chest CT scans.


CONCLUSIONS
Compared with chest radiograph, chest CT generated new findings in nearly 60% of SCAP patients, leading to new procedures or changes in medical treatment in nearly 75% of those patients. Chest CT better describes the pulmonary involvement and severity of oxygenation disorder compared to a plain chest radiograph.
Division of Intensive Care, Department of Anaesthesiology, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
J M
JM
Karhu
Division of Intensive Care, Department of Anaesthesiology, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
T I
TI
Ala-Kokko
Department of Radiology, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
L K
LK
Ahvenjärvi
Department of Radiology, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
E
E
Rauvala
Departments of Anaesthesiology and Surgery, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
P
P
Ohtonen
Department of Infection Control, Oulu University Hospital and Medical Research Center Oulu, Oulu University, Oulu, Finland.
H P T
HP
Syrjälä
D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*