We aimed to describe lung ultrasound (LUS) findings in COVID-19 pneumonia and to analyze the association with initial severity and outcome. Prospective cohort study among intensive care unit (ICU) patients in a teaching hospital in Tunisia. A 20-bed respiratory medical intensive care unit of Abderrahmen Mami Teaching Hospital from January to December 2021. We included all COVID-19 pneumonia patients managed in ICU. LUS examination and chest computed tomography (CT), when possible, were performed during the first 24 h of ICU stay. LUS findings were described and association with severity was analysed for trends. During the one-year study period, 311 patients were included with a median age of 58 IQR [47-67] years. ARDS was diagnosed in 307 patients (98.7%). Median initial PaO2/FiO2 was 112 IQR [81-157] mmHg. Median length of stay was 10 IQR [7-14] days and overall mortality was of 45.3%. Median LUS score was 29 IQR [25-32]. LUS score gradients were apico-basal and postero-antero-lateral. There was a significant correlation between ROX index and LUS score with r= -0.146 and p = 0.013. LUS score above 25 was significantly associated with chest CT damage exceeding 75% (NPV = 80.7%). LUS score under 25 was significantly associated with chest CT damage < 50% (NPV = 77.5%). No association was found between the LUS score and mortality or the need for invasive ventilation. In COVID-19 pneumonia, LUS is a good and safe tool for initial severity assessment. LUS score is correlated with ROX index and extent of chest damage on CT scan. However, LUS score does not predict outcome nor need for invasive mechanical ventilation.

Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1st January 2000 and 31st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.

BackgroundWe compared patients diagnosed at a SARI (severe acute respiratory infections) surveillance site with COVID-19 and those with seasonal influenza to investigate the clinical differences, common features, and outcomes.MethodsWe conducted a descriptive, retrospective study in the Medical Intensive Care Unit (ICU) at Abderrahman Mami Hospital between September 2021 and April 2022. Demographic, clinical, and biological data as well as outcomes were recorded for all patients.ResultsAmong 223 SARI patients, 83 were confirmed COVID-19, and 22 were influenza positive. The distribution according to gender was similar; but patients with influenza were younger than those suffering from COVID-19(mean age 60.36 SD 17.28 vs. 61.88 SD 17.91; P = 0.601). In terms of underlying chronic diseases, the frequency was 84.3% in the COVID-19 group and 72.7% in the influenza group. COVID-19 patients had a longer duration of hospitalization (mean [SD], 9.51 days [8.47 days] vs. 7.33 days [8.82 days]; P = 0.003), and a more frequent need for invasive ventilation (80 [97.4%] vs. 20 [92.3]). Case fatality was also higher among this group compared to the latter (39 [47%] vs. 6 [27.3%], P = 0.01).ConclusionThis exploratory study suggests higher severity of COVID-19 compared to seasonal influenza among SARI hospitalized patients even during the Omicron wave. Further research on higher sample sizes is required to confirm this conclusion.

Objective The aim of this study is to explore the role of IL6 in predicting outcome in critically ill COVID-19 patients. Design Prospective observational cohort study. Setting 20-bed respiratory medical intensive care unit of Abderrahmen Mami Teaching Hospital between September and December 2020. Methods We included all critically ill patients diagnosed with COVID-19 managed in ICU. IL6 was measured during the first 24 hours of hospitalization. Results 71 patients were included with mean age of 64 ± 12 years, gender ratio of 22. Most patients had comorbidities, including hypertension (n = 32, 45%), obesity (n = 32, 45%) and diabetes (n = 29, 41%). Dexamethasone 6 mg twice a day was initiated as treatment for all patients. Thirty patients (42%) needed high flow oxygenation; 59 (83%) underwent non-invasive ventilation for a median duration 2 [1–5] days. Invasive mechanical ventilation was required in 44 (62%) patients with a median initiation delay of 1 [0–4] days. Median ICU length of stay was 11 [7–17] days and overall mortality was 61%. During the first 24 hours, median IL6 was 34.4 [12.5–106] pg/ml. Multivariate analysis shows that IL-6 ≥ 20 pg/ml, CPK < 107 UI/L, AST < 30 UI/L and invasive ventilation requirement are independent risk factors for mortality. Conclusions IL-6 is a strong mortality predictor among critically ill COVID19 patients. Since IL-6 antagonist agents are costly, this finding may help physicians to consider patients who should benefit from that treatment.

INTRODUCTION:Pulmonary hypertension (PH) management can only be conceived in a specialized center. We aimed to report the experience of a Tunisian ICU about PH invasive hemodynamic exploration and to describe consequent therapeutic decisions. METHODS:Retrospective descriptive study including all patients admitted to the medical ICU of Abderrahmen Mami Hospital for right heart catheterization (RHC), between 2005 and 2019 as part of the investigation of PH. Patients' characteristics, procedure safety and arising therapeutic decisions were then reported. RESULTS:Forty patients were admitted for hemodynamic evaluation. RHC confirmed PH in 31 patients and exploration was then completed with NO reactivity test. Mean age was 41.3±15 years, gender ratio M/F was 1.06. PH was classified into: group 1 (n=13), group 2 (n=14), group 4 (n=2) and group 5 (n=2). NO vasoreactivity test was positive in 50% of post-capillary PH and in 28% of pre-capillary PH. The therapeutic decision following the reversibility test was: prescription of calcium channel blockers (n=5), a specific pulmonary vasodilator (n=10), operability (n=6), heart-lung transplant (n=3) and therapeutic abstention (n=7). Two minor complications were reported. CONCLUSION:The medical ICU in Abderrahmen Mami Hospital represents an experienced team in hemodynamic investigations despite low annual RHC number. NO reactivity test is an indispensable tool that enables important decisions during PH management.

Les maladies respiratoires chroniques (MRC) constituent un facteur de gravité pronostique pour certaines viroses à tropisme respiratoire, notamment la grippe. Qu’en est-il pour le SARS-CoV-2 ? Le but de ce travail était d’étudier les particularités cliniques et pronostiques des patients ayant des MRC, admis en réanimation pour pneumonie à SARS-CoV-2. Étude rétrospective observationnelle ayant inclus les patients admis pour pneumonie SARS-CoV-2 modérée à sévère, selon la définition de l’OMS, au service de réanimation médicale de l’hôpital Abderahmen Mami, entre mars 2020 et septembre 2021. Deux groupes de patients ont été identifiés : G1 : patients avec MRC ; G2 : patients sans MRC. Ont été recueillies : les données anamnestiques, cliniques et évolutives des patients. Cinq cent soixante-douze patients ont été inclus durant la période d’étude : G1 (n = 90 ; 15,7 %), G2 (n = 482, 84,3 %). Les patients du G1 étaient âgés en moyenne de 63,04 ans et les patients du G2 âgés de 58,56 ans (p = 0,001). Les MRC étaient essentiellement représentées par : l’asthme (n = 21), la bronchopneumopathie chronique obstructive (n = 38), les dilatations de bronches (n = 5) et le syndrome d’apnée obstructive du sommeil (n = 16). Le tabagisme était plus fréquemment retrouvé dans le G1 (p < 0,001). Le taux de vaccination contre la COVID-19 était comparable entre les deux groupes. Concernant la symptomatologie, la dyspnée était plus fréquente dans le G1 sans différence significative (p = 0,61). Le syndrome de détresse respiratoire aigu était léger (G1 : 11 % ; G2 : 13,3 %), modéré (G1 : 52,4 % ; G2 : 46,4 %) et sévère (G1 : 36,6 % ; G2 : 40,3 %) (p = 0,58). L’étendue des lésions scanographiques et la moyenne du score du LUS échographique étaient comparables entre les deux groupes (p respectivement de 0,06 et 0,87). Aucune différence significative sur le plan biologique n’a été retrouvée entre les deux groupes. L’utilisation de ventilation non invasive était comparable dans les deux groupes (G1 : 85,6 % ; G2 : 82 % ; p = 0,4). Sa durée était plus prolongée pour le G1 (p = 0,47). Le recours à la ventilation mécanique (VM) était de 57,8 % dans le G1 et de 57,1 % pour le G2 (p = 0,89). La durée de la VM et le risque de survenue de pneumopathies acquises sous VM étaient comparables entre les groupes (p respectivement de 0,72 et 0,86). La mortalité était plus importante dans le G1 (61,1 % contre 53,3 %) sans différence statistiquement significative (p = 0,17). En concordance avec la littérature, notre étude a montré que les pneumonies sévères à SARS-CoV-2 survenant chez des patients ayant des MRC n’étaient pas significativement plus graves ni grevées d’une morbi-mortalité plus importante.

Background: The worldwide SARS-CoV-2 pandemic represents the most recent global healthcare crisis. While all healthcare systems suffered facing the immense burden of critically-ill COVID-19 patients, the levels of preparedness and adaptability differed highly between countries. Aim: to describe resource mobilization throughout the COVID-19 waves in Tunisian University Medical Intensive Care Units (MICUs) and to identify discrepancies in preparedness between the provided and required resource.Methods: This is a longitudinal retrospective multicentre observational study conducted between March 2020 and May 2022 analyzing data from eight University MICUs. Data were collected at baseline and at each bed expansion period in relation to the nation's four COVID-19 waves. Data collected included epidemio-logical, organizational and management trends and outcomes of COVID-19 and non-COVID-19 admissions.Results: MICU-beds increased from 66 to a maximum of 117 beds. This was possible thanks to equipping pre-existing non-functional MICU beds (n = 20) and creating surge ICU-beds in medical wards (n = 24). MICU nurses increased from 53 to 200 of which 99 non-ICU nurses, by deployment from other departments and temporary recruitment. The nurse-to-MICU-bed ratio increased from 1:1 to around 1 center dot 8:1. Only 55% of beds were single rooms, 80% were equipped with ICU ventilators. These MICUs managed to admit a total of 3368 critically-ill patients (15% of hospital admissions). 33 center dot 2% of COVID-19-related intra-hospital deaths occurred within the MICUs.Conclusion: Despite a substantial increase in resource mobilization during the COVID-19 pandemic, the current study identified significant persisting discrepancies between supplied and required resource, at least partially explaining the poor overall prognosis of critically-ill COVID-19 patients.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).

Since the beginning of the Coronavirus disease-2019 pandemic, there has been a growing interest in exploring SARS-CoV-2 genetic variation to understand the origin and spread of the pandemic, improve diagnostic methods and develop the appropriate vaccines. The objective of this study was to identify the SARS-CoV-2s lineages circulating in Tunisia and to explore their amino acid signature in order to follow their genome dynamics. Whole genome sequencing and genetic analyses of fifty-eight SARS-CoV-2 samples collected during one-year between March 2020 and March 2021 from the National Influenza Center were performed using three sampling strategies.. Multiple lineage introductions were noted during the initial phase of the pandemic, including B.4, B.1.1, B.1.428.2, B.1.540 and B.1.1.189. Subsequently, lineages B1.160 (24.2%) and B1.177 (22.4%) were dominant throughout the year. The Alpha variant (B.1.1.7 lineage) was identified in February 2021 and firstly observed in the center of our country. In addition, A clear diversity of lineages was observed in the North of the country. A total of 335 mutations including 10 deletions were found. The SARS-CoV-2 proteins ORF1ab, Spike, ORF3a, and Nucleocapsid were observed as mutation hotspots with a mutation frequency exceeding 20%. The 2 most frequent mutations, D614G in S protein and P314L in Nsp12 appeared simultaneously and are often associated with increased viral infectivity. Interestingly, deletions in coding regions causing consequent deletions of amino acids and frame shifts were identified in NSP3, NSP6, S, E, ORF7a, ORF8 and N proteins.These findings contribute to define the COVID-19 outbreak in Tunisia. Despite the country's limited resources, surveillance of SARS-CoV-2 genomic variation should be continued to control the occurrence of new variants.

Objective: Anti COVID vaccines are efficient in preventing most severe forms of SARS-COV-2 infections. Nevertheless, many vaccinated patients are still at risk to have severe forms. We aimed to describe characteristics, severity and outcome of COVID-19 vaccinated patients admitted in ICU. Methods: A prospective study conducted between August 15th 2021 and February 20th 2022 in the ICU of Abderrahmen Mami hospital in Tunisia. Patients who received at least one dose of vaccine were included. Epidemiological characteristics, ventilation strategy and vaccine data were collected. Results: During the study period, 133 patients were admitted to the ICU, from whom 36 (27%) met the inclusion criteria. All of them received the first dose of the vaccine, 27 (75%) were fully vaccinated (2 doses); only 2 of them have received a booster dose (3rd dose). The majority of vaccinated patients were male (gender-ratio 2.3), mean age was 64 years. Thirty-one patients (86%) had at least one comorbidity. Reason for ICU admission was acute respiratory failure (n = 26; 72%) with high O2 needs or complications related to comorbidities (n = 10; 28 %). The mean P/F ratio at admission was 160 mmHg. Ventilatory requirement was: high flow nasal canula (22%), non-invasive ventilation (69.4%) and invasive ventilation (33%). ICU mortality among fully vaccinated patients (2 or 3 doses) was 55% (15/27). The most common cause of death was severe hypoxemia and/or a related complication. Only 5 patients died due to complications of their comorbidities. Conclusions: Vaccinated patients admitted in ICU were elderly and had comorbidities. ICU mortality among fully vaccinated remains high.

Background: During COVID-19 pneumonia management, CT scan is highly contributive. It represents the gold standard examination for both positive and severity diagnosis. Objective: We aimed to compare 2 methods of evaluation of CT scan involvement. Methods: We conducted a prospective cohort study in the ICU of Abderrahmen Mami hospital between January and December 2021. We included critically-ill patients COVID-19 who had a CT scan. We considered two ways to evaluate severity of lung damage: 1/Percentage of lung damage extent (< 50%, 50 to 75% and ≥ 75%), 2/ CT score (assimilated to Lung Ultrasound Score): Subdivision of each hemithorax into 6 regions: antero-superior and inferior, latero-superior and inferior, postero-superior and inferior. A score was attributed according to the patterns: 0 if normal parenchyma, 1 if few ground-glass lesions, 2 if extensive ground-glass lesions, and 3 if condensations. CT score was the sum of the scores of the 12 regions, thus varying between 0 and 36. Results: We included 158 patients with mean age of 56 ± 13 years and gender ratio of 1.6. Mean values of SAPS II and APACHE II were respectively 25.4±7.7 and 8.7±5. Mean initial PaO2/FiO2 was 127.4 ± 59.7mmHg and ARDS was diagnosed in 153 (98%) patients. The CT extent was distributed as <50 % (27.3 %), [50% - 75 %] (37.8 %) and > 75 % (34.9 %). Mean CT score was 19.4±5.8 [5 - 34]. The comparison of the 2 methods, showed a statistically significant result between the CT score and a damage < 50% (p = 0.002), and also between CT score and a damage ≥ 75% (p = 0.003). Conclusion: In COVID-19 pneumonia, lung damage extent seems to be appreciated with percentages as well as CT score. An external validity is mandatory for CT-scan score.

Introduction Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. Methods It was a single-center study, including all hospitalized patients in intensive care, between November 1 st , 2009 and October 31 st , 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. Results During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H 1 N 1 pdm09 (84.2%) and H 3 N 2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25–13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC 95% [1.474–37.317]; p = 0.015), PaO 2 /FiO 2 ≤ 95 mmHg (OR = 9.078; IC 95% [1.636–50.363]; p = 0.012) and lymphocytes count ≤ 1.325 10 9 /L (OR = 10.199; IC 95% [1.550–67.101]; p = 0.016). Conclusion Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.

The use of non-invasive ventilation (NIV) after extubation may improve patient’s conditions. The aim of our study was to analyze the impact of the use of NIV after extubation on outcome. Methods: This was a monocentric, observational, descriptive, and retrospective study carried out during 2018 at the intensive care unit. Patients who received NIV after extubation, were included. The impact on outcome was analyzed based on the risk of intubation and the death. Results: During the study period, 194 patients were intubated, of which 46 received post-extubation NIV. The average age was 61±15 years. NIV was preventive in 27 patients (59%), systematic in 15 (32%) and therapeutic in 4 (9%). The reintubation rate was 28% in a mean delay of 3±2 days. The mean length of stay in intensive care was 17±15 days and the mean length of stay in hospital was 20±17 days. Mortality rate was 24%. Reintubation was associated in univariate analysis with a prolonged duration of weaning (p =0.023), a need of systematic NIV (p=0.054) and the use of higher levels of pressure support (p=0.005). In multivariate analysis, systematic NIV (p=0.048) and high levels of pressure support (p=0.023) were independent risk factors of reintubation. Mortality was associated in the univariate analysis with: admission for metabolic disorder (p=0.012), pneumonia or tracheobronchitis associated to ventilation: p=0.006 and p=0.025. In multivariate analysis, reintubation was the only independent risk factor of mortality. Post-extubation NIV did not impact mortality. Conclusions: Ventilator weaning with early extubation to NIV was associated with a significant risk of reintubation. However, this practice was not an independent risk factor for post-extubation mortality.

Des séquelles respiratoires après la phase aiguë de certaines pneumonies virales graves ont été décrites. Chercher d'éventuelles séquelles fonctionnelles et radiologiques chez les patients guéris de la COVID-19. Étude prospective au service de réanimation médicale de l'hôpital Abderrahmen Mami de l'Ariana entre janvier et mars 2020. À 3 mois de la sortie, les patients guéris ont eu une évaluation clinique (échelle de Borg modifiée, échelle de fatigue MFI-20), radiologique (TDM thoracique) et fonctionnelle respiratoire (spirométrie, pléthysmographie, pressions inspiratoires et expiratoires maximales [PImax PEmax], test de marche de 6 min [TM6 min], DLCO). Quatorze survivants parmi 28 patients hospitalisés en réanimation pour une pneumonie à SARS-COV-2 ont été inclus (Fig. 1). L'âge moyen était de 62 ans. Le genre-ratio était de 0,75. Tous avaient nécessité l'O2 et 2/14 ont été intubés. Les anomalies radiologiques (TDM à l'admission) constatées étaient le verre dépoli (11/14), les condensations (8/14), les distorsions parenchymateuses avec bronchectasies de traction (2/14) et les épanchements pleuraux (1/14). L'étendue de l'atteinte pulmonaire retrouvée était minime < 10 % (3/14), modérée 10–25 % (6/14) et étendue 25–50 % (5/14). Le contrôle clinique à 3 mois de la sortie a montré la persistance d'une anosmie (4/14) et d'une dyspnée (8/14) importante (échelle de Borg cotée entre 7 et 10). Sept patients se plaignaient d'asthénie importante (MFI-20 > 14). La TDM de contrôle a révélé la disparition totale des lésions (10/14), persistance de verre dépoli et des condensations (3/14) et une distorsion scissurale avec fibrose (4/14). L'EFR a montré un syndrome restrictif (10/14), avec une capacité pulmonaire totale moyenne à 4323 ± 3038 mL (106 % ± 19 %), une diminution de la DLCO (4/14) avec un rapport moyen entre la diffusion libre du monoxyde de carbone et la ventilation alvéolaire à 79 % [68—123]. L'exploration des muscles respiratoires a montré des PImax PEmax moyennes à −22,6 ± 76 cmH2O et 79,6 ± 98 cmH2O. Cinq patients ont présenté une désaturation au TM6 min. En réanimation, les survivants de la COVID-19 ont gardé une asthénie importante, un déconditionnement à l'effort, un trouble ventilatoire restrictif par faiblesse des muscles respiratoires et/ou par une fibrose pulmonaire secondaire avec troubles de la diffusion et déconditionnement à l'effort. Une prise en charge pluridisciplinaire en réhabilitation peut s'avérer nécessaire pour améliorer les chances de récupération.

Maladie émergeante d'actualité, la COVID-19 est crainte pour l'atteinte respiratoire dont elle peut être responsable et qui conditionne largement le pronostic vital. D'autres conséquences moins connues, les séquelles mentales, peuvent être observées et ne sont dévoilées que lors de la guérison du malade. Rechercher des troubles cognitifs, anxieux et dépressifs, dépister un trouble de stress post-traumatique (TSPT) et évaluer la qualité de vie des patients de réanimation guéris de la COVID19. Étude prospective menée au service de réanimation médicale de l'hôpital Abderrahmen Mami de l'Ariana entre janvier et mars 2020. À 3 mois de leur sortie, les survivants ont bénéficié d'une évaluation cognitive (Mini Mental State MMS) et ont répondu à 3 questionnaires: HADS (dépistage d'un syndrome anxiodépressif), SPRINT (rechercher un TSPT) et le SF12 (calculer un score de qualité de vie mentale et un score de qualité de vie physique). Vingt-huit patients ont été hospitalisés en milieu de réanimation pour une pneumonie à SARS-COV2, 14 ont survécu. L'âge moyen était de 62,2 ans, et le genre-ratio de 0,75. Les comorbidités étaient dominées par l'HTA (8/14), l'obésité (5/14) et le diabète (4/14). Deux patients ont nécessité une ventilation invasive de 11 jours en moyenne; 12/14 avaient une atteinte modérée nécessitant une oxygénothérapie seule. Le contrôle à 3 mois a trouvé que 2/14 patients avaient un trouble cognitif avec un score MMS < 24, 6/14 avaient une insomnie. Un syndrome dépressif a été retrouvé chez 3 patients ayant un score HAD à 15, 17 et 20 respectivement. Un syndrome anxieux a été diagnostiqué chez un patient dont le score HAD était coté à 11. Des symptômes de TSPT sévère (SPRINT entre 18 et 32) ont été retrouvés chez 4 patients et léger (SPRINT entre 7 et 10) chez 2 patients. Ces séquelles psychiatriques étaient significativement associées à la présence de comorbidités (p = 0,03). La présence de troubles cognitifs était significativement corrélée à une altération de la qualité de vie dans sa dimension physique (p = 0,04) mais pas dans sa dimension mentale. La moitié des patients n'ont pas repris leurs activités professionnelles à 3 mois. En réanimation, les survivants de la COVID 19 sont à risque élevé de séquelles psychiatriques et cognitives altérant significativement leur qualité de vie. Ainsi un suivi psychologique, des stratégies de soutien psychosocial et une rééducation neurocognitive précoce doivent être envisagées chez ces patients.

Background: COPD represents a major public health problem worldwide because of its high prevalence and socio-economic repercussions. In Tunisia, few studies focused on the burden of this disease. We aimed to estimate the cost of ICU hospitalization due to COPD exacerbation; then to investigate higher cost associated factors. Methods: This retrospective study included all patients admitted in ICU) of Abderrahmen Mami hospital for COPD exacerbation, between, January 1st and December 31, 2016. We estimated of the cost of the hospitalization based on all prescribed laboratory tests, treatments, consumable necessary for their use as well as all complementary examinations and explorations carried out during the ICU-stay. An univariate analysis was performed to determine higher cost associated factors. The estimated cost was expressed in Tunisian dinars(TND) and in Euros(€) according to change course in 2016 (1€=2.43 TND). Results: We included 190 patients aged of 67±11 years and 85% of them was men. All patients had an acute respiratory failure, 40 of them were in coma and 14 were in shock. The mean length of ICU stay was 9.2 ± 9 days. The mean cost of COPD exacerbation hospitalisation in ICU was 2471±2517 TND(1017±1036€). The daily mean cost per patient was 333±210 TND(137±86€). Total expenses in 2016 for COPD exacerbation in ICU was 469735 TND(193307€). Higher mean cost associated factors were: need to invasive mechanical ventilation (3505TND vs 1370TND;p<10-3) and one or more complication (4161TND vs 1242TND;p<10-3). Conclusions: The estimated cost of exacerbations of COPD in intensive care is very high.To reduce these costs, optimization of non-invasive ventilation should be promoted.

L'insuffisance rénale aiguë (IRA) affecte 20 à 40 % des patients admis en réanimation pour COVID-19. L'objectif de notre étude était d'étudier les particularités de l'IRA associée à la COVID-19. Il s'agissait d'une étude prospective analytique colligeant les patients du service de réanimation Abderrahmane-Mami, pour COVID-19 entre mars et mai 2020. Nous avons réparti les patients en deux groupes : G1 (IRA) et G2 (pas d'IRA). Nous avons colligé 28 patients de genre ratio (H/F) = 1,33. Dix patients (35,7 %) avaient une IRA dont 7 (25 %) étaient oligo-anuriques. La répartition selon KDIGO : IRA stade 1 (n = 4) et stade 3 (n = 6). L'étiologie était fonctionnelle dans 4 cas et organique dans 6 cas. Les patients de G1 étaient plus âgés (73 vs 62 ans, p = 0,033) sans différence significative des comorbidités ni du traitement de fond. Le syndrome de détresse respiratoire aiguë était significativement plus fréquent chez les patients du G1 (p = 0,016). La néphrotoxicité médicamenteuse (n = 2), l'injection de produits de contraste iodée (n = 16) et la rhabdomyolyse (n = 3) n'étaient pas significativement plus fréquentes dans G1. Un état de choc était observé chez 7 patients du G1 vs 3 patients du G2 (p = 0,011). L'état de choc hypovolémique était statistiquement plus fréquent chez les patients du G1 (6 vs 1, p = 0,004). Le recours à la ventilation invasive était significativement plus fréquent chez les patients du G1 avec un p = 0,005. Trois patients ont eu une séance d'épuration extrarénale : intermittente (n = 2) et continue (n = 1). Une reprise de la fonction rénale était notée chez 2 patients. Après un suivi médian de 7 jours, 9 patients du G1 sont décédés contre 1 patient du G2 (p = 0,004). L'oligoanurie était significativement associée à une augmentation de la mortalité (0 % vs 25 %, p = 0,015). L'IRA était fréquente au cours de la COVID-19. Elle est associée à une augmentation de la mortalité, en particulier lorsqu'elle est oligoanurique.

The management of acute respiratory distress syndrome (ARDS) is essentially based on mechanical ventilation. The choice of NIV as ventilatory assistance during the ARDS remains a controversial issue and no recommendations are made. We aimed to establish independent predictive factors of NIV failure within ARDS. Methods: This was a retrospective study between January 2015 and March 2019, conducted in the respiratory intensive care unit of Abderrahmen Mami Hospital. Patients admitted for ARDS according to the Berlin criteria and receiving 1st line NIV/CPAP were included. Clinical, ventilatory and evolving features were collected. An univariate and then multivariate analysis were conducted to determine predictive factors of NIV failure. Results: During the study period, 102 patients were included. The median age was 55 years and the sex-ratio was 1.48. At admission, the ARDS was severe (n=50;49%), moderate (n=40;39%) and mild (n=12;12%). NIV was the initial ventilatory modality in 79.4% of cases and CPAP in 20.6% of patients. The NIV failure rate was 71.6% with a median delay of 1 day[1-11]. The factors associated with NIV failure were: age (58 vs. 45 years; p=0.008), APACHE II (15.5 vs. 9; p=0.001), respiratory comorbidities (31.5% vs. 10.3% ; p=0.027), severe ARDS (57.5% vs 27.5%; p =0.004), viral etiology (11% vs 38%; p=0.001) and initial PEEP level setting(8 vs 10; p=0.016). The independent predictors of NIV failure identified were severe ARDS (OR=45.4;IC95%[1.6-125.2];p=0.024)and a PEEP level less than 9 cmH2O(OR=23;IC95%[1.2-408];p=0.033). Conclusion: NIV failure rate within ARDS was 71.6%. The independent predictors of NIV failure identified were severe ARDS and a PEEP level less than 9 cmH2O.