Dissociation between the clinical course and chest imaging in severe COVID-19 pneumonia: A series of five cases.
Damien Basille, Marie-Anne Auquier, Claire Andréjak and 3 others
PMID 34271253WHAT IT FOUND
Five ICU patients with severe COVID-19 showed significant clinical improvement in blood oxygen levels while their chest imaging remained stable or worsened.
This dissociation suggests chest imaging may not reliably track recovery or diagnose the extent of lung damage in these cases.
Key findings
01All five patients showed a statistically significant increase in the PaO2:FiO2 ratio (a measure of oxygen exchange) despite stable or worsening chest imaging findings.
02The mean PaO2:FiO2 ratio improved from 113.2 mmHg at admission to 259.8 mmHg at follow-up, indicating better oxygenation even when scans did not show lung healing.
03The authors hypothesize that an intrapulmonary shunt (blood flowing through lungs without picking up oxygen) may be a key mechanism, which resolves independently of lung tissue damage visible on scans.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study includes only five patients, making it a case series rather than a controlled trial. Most follow-up imaging (28 of 46 patients) was done with chest X-rays, which are less sensitive than CT scans and may misclassify specific lung features like ground-glass opacities. The authors note that the mechanism for the improved oxygenation is hypothetical (intrapulmonary shunt resolution) and not directly measured in these patients.
Declared interests
The authors do not report any conflict of interest.
The easy way to misread this
Do not assume that worsening or stable chest imaging means a patient is failing to recover. In these cases, oxygenation improved significantly despite static scans, so clinical and blood gas markers should drive care decisions more than imaging alone.