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Negri S, Mazzuca E, Lococo F, Mondoni M, Covino M, Kuzmych K, Agati S, Amata M, Arcoleo G, Gabbrielli L, Pancani R, Tedeschi E, Baiamonte P, Sassu A, Patrucco F, Foci V, Marchetti G, Vernuccio F, Zanardi E, Gaccione AT, Sorino C. Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study. Respir Med 2024; 230:107684. [PMID: 38823564 DOI: 10.1016/j.rmed.2024.107684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND An increased incidence of pneumomediastinum has been observed among patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. The study aimed to identify risk factors for COVID-19-associated pneumomediastinum and investigate the impact of pneumomediastinum on clinical outcomes. METHODS In this multicentre retrospective case-control study, we included consecutive patients with COVID-19 pneumonia and pneumomediastinum hospitalized from March 2020 to July 2020 at ten centres; then, we identified a similarly sized control group of consecutive patients hospitalized with COVID-19 pneumonia and respiratory failure who did not develop pneumomediastinum during the same period. Clinical, laboratory, and radiological characteristics, as well as respiratory support and outcomes, were collected and compared between the two groups. Risk factors of pneumomediastinum were assessed by multivariable logistic analysis. RESULTS Overall 139 patients with pneumomediastinum and 153 without pneumomediastinum were analysed. Lung involvement ≥75 %, consolidations, body mass index (BMI) < 22 kg/m2, C-reactive protein (CRP) > 150 mg/L, D-dimer >3000 ng/mL FEUs, and smoking exposure >20 pack-year were all independently correlated with the occurrence of pneumomediastinum. Patients with pneumomediastinum had a longer hospital stay (mean ± SD 31.2 ± 20.2 days vs 19.6 ± 14.2, p < 0.001), higher intubation rate (73/139, 52.5 % vs 27/153, 17.6 %, p < 0.001), and in-hospital mortality (68/139, 48.9 % vs 36/153, 23.5 %, p < 0.001) compared to controls. CONCLUSIONS Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with a greater risk of pneumomediastinum in COVID-19 pneumonia. This complication significantly worsens the outcomes.
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Affiliation(s)
- Stefano Negri
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Emilia Mazzuca
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marcello Covino
- Emergency Department - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Agati
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Marta Amata
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ersilia Tedeschi
- Pulmonology, Ente Ecclesiastico Ospedale "F. Miulli" Acquaviva delle Fonti-Bari, Italy
| | | | - Alessandro Sassu
- Pulmonology and Semintensive Respiratory Unit, Ospedale Santissima Trinità, Cagliari, Italy
| | - Filippo Patrucco
- Pulmonology, Dipartimento Medico, AOU Maggiore della Carità di Novara, Italy
| | - Valentina Foci
- Pulmonology, Ospedali Riuniti di Livorno, Azienda Usl Toscana Nord-Ovest, Italy
| | | | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Erika Zanardi
- Pulmonology, Ospedale di Cittadella, AULSS6-Euganea, Padova, Italy
| | | | - Claudio Sorino
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy; Faculty of Medicine and Surgery, University of Insubria, Varese, Italy.
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Tekin A, Devarajan A, Sakata KK, Qamar S, Sharma M, Valencia Morales DJ, Malinchoc M, Talaei F, Welle S, Taji J, Khosa S, Sharma N, Brown M, Lal A, Bansal V, Khan SA, La Nou AT, Sanghavi D, Cartin-Ceba R, Kashyap R, Gajic O, Domecq JP, Azadeh N. Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study. Heliyon 2024; 10:e33679. [PMID: 39055836 PMCID: PMC11269848 DOI: 10.1016/j.heliyon.2024.e33679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Objective To describe the characteristics of COVID-19 patients with pneumothorax and pneumomediastinum (PTX/PM) and their association with patient outcomes. Patients and methods Adults admitted to five Mayo Clinic hospitals with COVID-19 between 03/2020-01/2022 were evaluated. PTX/PM was defined by imaging. Descriptive analyses and a matched (age, sex, admission month, COVID-19 severity) cohort comparison was performed. Hospital mortality, length of stay (LOS), and predisposing factors were assessed. Results Among 6663 patients, 197 had PTX/PM (3 %) (75 PM, 40 PTX, 82 both). The median age was 59, with 71 % males. Exposure to invasive and non-invasive mechanical ventilation and high-flow nasal cannula before PTX/PM were 42 %, 17 %, and 20 %, respectively. Among isolated PTX and PM/PTX patients 70 % and 53.7 % underwent an intervention, respectively, while 96 % of the PM-only group was followed conservatively.A total of 171 patients with PTX/PM were compared to 171 matched controls. PTX/PM patients had more underlying lung disease (40.9 vs. 23.4 %, p < 0.001) and lower median body mass index (BMI) (29.5 vs. 31.3 kg/m2, p = .007) than controls. Among patients with available data, PTX/PM patients had higher median positive end-expiratory and plateau pressures than controls; however, differences were not significant (10 vs. 8 cmH2O; p = 0.38 and 28 vs. 22 cmH2O; p = 0.11, respectively). PTX/PM patients had a higher odds of mortality (adjusted odds ratio [95%CI]: 3.37 [1.61-7.07]) and longer mean LOS (percent change [95%CI]: 39 [9-77]) than controls. Conclusion In COVID-19 patients with similar severity, PTX/PM patients had more underlying lung disease and lower BMI. They had significantly increased mortality and LOS.
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Affiliation(s)
- Aysun Tekin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anusha Devarajan
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Kenneth K. Sakata
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Shahraz Qamar
- Post-Baccalaureate Research Education Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mayank Sharma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Fahimeh Talaei
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Stephanie Welle
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Jamil Taji
- Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
| | - Sandeep Khosa
- Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
| | - Nikhil Sharma
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Meghan Brown
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vikas Bansal
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Syed Anjum Khan
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Abigail T. La Nou
- Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Research, WellSpan Health, York, PA, USA
| | - Ognjen Gajic
- Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Juan P. Domecq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natalya Azadeh
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Laverty RB, Ivins-O'Keefe KM, Adams AM, Flatley MJ, Sobieszczyk MJ, Mason PE, Sams VG. Tube Thoracostomy Complications in Patients With ARDS Requiring ECMO: Worse in COVID-19 Patients? Mil Med 2024; 189:e1016-e1022. [PMID: 38079460 DOI: 10.1093/milmed/usad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO. MATERIALS AND METHODS This study is a single institution, retrospective cohort study of patients with COVID-19 ARDS requiring V-V ECMO. The control cohort consisted of patients who required V-V ECMO for ARDS-related diagnoses from January 2018 to January 2021. The primary outcome was any complication following initial tube thoracostomy placement. Study approval was obtained from the Brooke Army Medical Center Institutional Review Board (C.2017.152d). RESULTS Twenty-five COVID-19 patients and 38 controls were included. Demographic parameters did not differ between the groups. The incidence of pneumothorax was not significantly different between the two groups (44% COVID-19 vs. 22% control, OR 2.8, 95% CI 0.95-7.9, P = 0.09). Patients with COVID-19 were as likely to receive tube thoracostomy as controls (36% vs. 24%, OR 1.8, 95% CI 0.55-5.7). Complications, however, were more likely to occur in the COVID-19 group (89% vs. 33%, OR 16, 95% CI, 1.6-201, P = 0.0498). CONCLUSIONS Tube thoracostomy placement in COVID-19 patients with ARDS requiring V-V ECMO is common, as are complications following initial placement. Clinicians should anticipate the need for re-intervention in this patient population. Small-bore (14Fr and smaller) pigtail catheters appeared to be safe and efficacious in this setting, but further study on tube thoracostomy management in ECMO patients is needed.
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Affiliation(s)
- Robert B Laverty
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Kelly M Ivins-O'Keefe
- Department of Anesthesiology, US Army Institute of Surgical Research Burn Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Meaghan J Flatley
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michal J Sobieszczyk
- Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Phillip E Mason
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Valerie G Sams
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
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Liao KM, Chiu CC, Lu HY. The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan. Respir Med 2024; 228:107672. [PMID: 38763446 DOI: 10.1016/j.rmed.2024.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. METHODS In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. RESULTS We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. CONCLUSION Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yun-Lin, Taiwan.
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Bruni A, Battaglia C, Bosco V, Pelaia C, Neri G, Biamonte E, Manti F, Mollace A, Boscolo A, Morelli M, Navalesi P, Laganà D, Garofalo E, Longhini F. Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome. J Clin Med 2024; 13:2871. [PMID: 38792413 PMCID: PMC11122218 DOI: 10.3390/jcm13102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.
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Affiliation(s)
- Andrea Bruni
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Caterina Battaglia
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Eugenio Biamonte
- Institute of Anesthesia and Intensive Care, Dulbecco Hospital, 88100 Catanzaro, Italy;
| | - Francesco Manti
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Annachiara Mollace
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Annalisa Boscolo
- Department of Medicine (DIMED), University of Padua, 35131 Padua, Italy; (A.B.); (P.N.)
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35122 Padova, Italy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35122 Padova, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynecology, “Annunziata” Hospital, 87100 Cosenza, Italy;
| | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padua, 35131 Padua, Italy; (A.B.); (P.N.)
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35122 Padova, Italy
| | - Domenico Laganà
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
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Angelini M, Belletti A, Landoni G, Zangrillo A, De Cobelli F, Palumbo D. Macklin Effect: From Pathophysiology to Clinical Implication. J Cardiothorac Vasc Anesth 2024; 38:881-883. [PMID: 38378321 DOI: 10.1053/j.jvca.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 02/22/2024]
Abstract
Air leak syndromes (such as pneumomediastinum, pneumothorax, or subcutaneous emphysema) are frequent complications of acute respiratory distress syndrome (ARDS). Unfortunately, the development of air leaks is associated with worse outcomes. In addition, it has been hypothesized that the development of pneumomediastinum could be a marker of disease severity in patients with respiratory failure receiving noninvasive respiratory support or assisted ventilation. The so-called Macklin effect (or pulmonary interstitial emphysema) is the air dissection of the lung bronchovascular tree from peripheral to central airways following injury to distal alveoli. Ultimately, the progression of the Macklin effect leads to the development of pneumomediastinum, subcutaneous emphysema, or pneumothorax. The Macklin effect is identifiable on a chest computed tomography (CT) scan. The Macklin effect could be an accurate predictor of barotrauma in patients with ARDS (sensitivity = 89.2% [95% CI: 74.6-96.9]; specificity = 95.6% [95% CI: 90.6-98.4]), and may be a marker of disease severity. Accordingly, the detection of the Macklin effect on a chest CT scan could be used to select which patients with ARDS might benefit from different treatment algorithms, including advanced respiratory monitoring, early intubation, or, potentially, the institution of early extracorporeal support with or without invasive ventilation. In this video, the authors summarize the pathophysiology and potential clinical significance and applications of the Macklin effect in patients with acute respiratory failure.
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Affiliation(s)
- Matteo Angelini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kim AD, Silver JA, Chan DS, Khalife S, Kardash KJ, Yang SS, Marchica C, Manoukian J. Unwanted Inflation From Jet Ventilation: A Severe Barotrauma-Related Complication. EAR, NOSE & THROAT JOURNAL 2024:1455613241237082. [PMID: 38477503 DOI: 10.1177/01455613241237082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Anne Doyoung Kim
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Jennifer A Silver
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - David S Chan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Sarah Khalife
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Kenneth J Kardash
- Department of Anesthesia, Jewish General Hospital, Montreal, QC, Canada
| | - Stephen S Yang
- Department of Anesthesia, Jewish General Hospital, Montreal, QC, Canada
| | - Cinzia Marchica
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, Montreal, QC, Canada
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Gayen S, Dachert S, Lashari BH, Gordon M, Desai P, Criner GJ, Cardet JC, Shenoy K. Critical Care Management of Severe Asthma Exacerbations. J Clin Med 2024; 13:859. [PMID: 38337552 PMCID: PMC10856115 DOI: 10.3390/jcm13030859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients.
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Affiliation(s)
- Shameek Gayen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Stephen Dachert
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Bilal H. Lashari
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Parag Desai
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL 33602, USA;
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
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Wang CH, Lin T, Chen G, Lee MR, Tay J, Wu CY, Wu MC, Roth HR, Yang D, Zhao C, Wang W, Huang CH. Deep Learning-based Diagnosis and Localization of Pneumothorax on Portable Supine Chest X-ray in Intensive and Emergency Medicine: A Retrospective Study. J Med Syst 2023; 48:1. [PMID: 38048012 PMCID: PMC10695857 DOI: 10.1007/s10916-023-02023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To develop two deep learning-based systems for diagnosing and localizing pneumothorax on portable supine chest X-rays (SCXRs). METHODS For this retrospective study, images meeting the following inclusion criteria were included: (1) patient age ≥ 20 years; (2) portable SCXR; (3) imaging obtained in the emergency department or intensive care unit. Included images were temporally split into training (1571 images, between January 2015 and December 2019) and testing (1071 images, between January 2020 to December 2020) datasets. All images were annotated using pixel-level labels. Object detection and image segmentation were adopted to develop separate systems. For the detection-based system, EfficientNet-B2, DneseNet-121, and Inception-v3 were the architecture for the classification model; Deformable DETR, TOOD, and VFNet were the architecture for the localization model. Both classification and localization models of the segmentation-based system shared the UNet architecture. RESULTS In diagnosing pneumothorax, performance was excellent for both detection-based (Area under receiver operating characteristics curve [AUC]: 0.940, 95% confidence interval [CI]: 0.907-0.967) and segmentation-based (AUC: 0.979, 95% CI: 0.963-0.991) systems. For images with both predicted and ground-truth pneumothorax, lesion localization was highly accurate (detection-based Dice coefficient: 0.758, 95% CI: 0.707-0.806; segmentation-based Dice coefficient: 0.681, 95% CI: 0.642-0.721). The performance of the two deep learning-based systems declined as pneumothorax size diminished. Nonetheless, both systems were similar or better than human readers in diagnosis or localization performance across all sizes of pneumothorax. CONCLUSIONS Both deep learning-based systems excelled when tested in a temporally different dataset with differing patient or image characteristics, showing favourable potential for external generalizability.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Zhongzheng Dist., 100, Taiwan
| | - Tzuching Lin
- Institute of Applied Mathematical Sciences, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 106, Taiwan
| | - Guanru Chen
- Institute of Applied Mathematical Sciences, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 106, Taiwan
| | - Meng-Rui Lee
- Department of internal medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Joyce Tay
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Zhongzheng Dist., 100, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Zhongzheng Dist., 100, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Zhongzheng Dist., 100, Taiwan
| | | | | | - Can Zhao
- NVIDIA Corporation, Bethesda, USA
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 106, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Zhongzheng Dist., 100, Taiwan.
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10
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Idries IY, Khristoforov V, Yadav R, Sur A, Yadav V, Hossny A, Kalambay J, Zaman M. Papilledema Secondary to Barotrauma in a Young Adult With Severe Status Asthmaticus With Ventilatory Failure, Pneumothorax, and a Complex Clinical Course. Cureus 2023; 15:e50044. [PMID: 38186471 PMCID: PMC10768707 DOI: 10.7759/cureus.50044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Intubation and mechanical ventilation are common therapeutic interventions in intensive care unit settings. Barotrauma is a known complication of using positive pressures in a tissue defined by extra alveolar air in locations where it is not generally found in patients receiving mechanical ventilation. Several clinical manifestations of barotrauma include pneumothorax, subcutaneous emphysema, pneumoperitoneum, pneumomediastinum or pneumopericardium, air embolization, and hyperinflated left lower lobe. However, papilledema is an unreported and uncommon complication we observed in one of our patients, making it a unique presentation. We present the case of a young male patient intubated for asthma exacerbation requiring mechanical ventilation with subsequent development of papilledema. Our case report highlights the importance of knowing this rare complication of barotrauma as early commencement of lung-protective strategies will help prevent it.
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Affiliation(s)
- Iyad Y Idries
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Vasilii Khristoforov
- Intensive Care Unit, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Avtar Sur
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Ahmed Hossny
- Internal Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Mohammad Zaman
- Critical Care Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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11
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Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V, De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology 2023; 29:457-468. [PMID: 36669936 PMCID: PMC9684110 DOI: 10.1016/j.pulmoe.2022.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. METHODS This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. RESULTS We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). CONCLUSIONS C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. TRIAL REGISTRATION this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Paolo Navalesi
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | | | - Giovanni Ferrari
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Daniela Francisi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Simone Meini
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | | | - Emanuela Sozio
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo De Robertis
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Chiara Aldieri
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Elisa Baratella
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Barbara Burgazzi
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vito Catalanotti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Alessandro De Simoni
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Roberta Di Tria
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Sara Forlani
- Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Lococo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Sara Mehrabi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Sabrina Morosi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Mura
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy; Respiratory and Critical Care Unit, Sant Orsola University Hospital, Bologna, Italy
| | - Riccardo Pol
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Nguyen Hoang Quyen
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Elda Righi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Scabini
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Angelo Scarda
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Marcella Sibani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Evelina Tacconelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gennaro Tartaglione
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Eleonora Vania
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Visentin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Umberto Zuccon
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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12
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Carleton L, Eilbert W, Grant R. Extensive subcutaneous emphysema treated with subcutaneous angiocatheters. J Am Coll Emerg Physicians Open 2023; 4:e13054. [PMID: 37840863 PMCID: PMC10568045 DOI: 10.1002/emp2.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Subcutaneous emphysema (SCE) seen in the emergency department is usually the result of traumatic chest injuries, surgical complications, or invasive airway procedures. SCE is usually a self-limiting phenomenon involving the chest wall and neck, though may progress to involve the deeper tissues leading to respiratory and cardiovascular compromise. Emergent intervention is indicated in such cases of extensive SCE, though the ideal approach to its management is not known. We report a case of successful decompression of extensive SCE using subcutaneous placement of angiocatheters.
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Affiliation(s)
- Lena Carleton
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
| | - Wesley Eilbert
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
| | - Randall Grant
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
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13
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Xu J, Tian L, Han X. Successful treatment of near-fatal asthma with ECMO: A case report and literature review. Int J Artif Organs 2023; 46:532-536. [PMID: 37345330 DOI: 10.1177/03913988231182163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Near-fatal asthma (NFA) can lead to severe hypercapnia and sudden cardiac arrest; however, it can be reversed by extracorporeal membrane oxygenation (ECMO). We report a case of a 37-year-old male diagnosed with NFA. After fluid rehydaration, spasmolysis, and treatment with glucocorticoid and mechanical ventilation, the patient's condition improved temporarily. However, his condition worsened rapidly, and the patient presented with progressive respiratory distress, a sharp increase in airway pressure, decreased tidal volume, and barotrauma. The patient was treated with venovenous ECMO in the prone position. Five days later, the patient was successfully weaned from ECMO. Hence, ECMO could be used for NFA at the right time to provide adequate gas exchange for patients in order to reduce lung damage and prevent death.
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Affiliation(s)
- Junxian Xu
- Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Lijun Tian
- Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Xudong Han
- Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong University, Nantong, China
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14
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Selvanayagam LS, Pallewatte AS, Sivansuthan S. Spontaneous Subcutaneous Emphysema in a Teenage Male Extending As Pneumomediastinum, Pneumothorax, Pneumopericardium, and Epidural Pneumatosis: A Rare Combination of Anatomical Locations. Cureus 2023; 15:e43462. [PMID: 37711916 PMCID: PMC10498936 DOI: 10.7759/cureus.43462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal, pericardial, and pleural space together is rare, while epidural pneumatosis is an even rarer entity. We report a previously healthy teenage male with sudden onset chest pain whose plain radiographs and high-resolution computed tomography (HRCT) showed extensive spread of air in the mediastinum, pericardial space, pleural space, and epidural space. He was hemodynamically stable and had a spontaneous recovery after one week. Follow-up radiological imaging showed complete radiological resolution of gas lucencies. It is quite important for clinicians to be aware of this condition, common and rare routes of extension, and possible complications. Clinical suspicion is vital to plan appropriate investigations especially radiological modalities such as chest X-ray and HRCT. This will help in evaluating the severity of the condition, exclude possible etiologies, and look for potential complications so that proper management and follow-up can be planned.
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Affiliation(s)
- Lagitha S Selvanayagam
- Internal Medicine, Post Graduate Institute of Medicine, University of Colombo, Colombo, LKA
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15
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Bansal S, Furtado A, Kalpakam H, Loknath C, Mehta RM. A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients. Respirol Case Rep 2023; 11:e01173. [PMID: 37383366 PMCID: PMC10293885 DOI: 10.1002/rcr2.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
ARDS in general and severe COVID ARDS (CARDS) is particularly associated with high rates of barotrauma. Two cases with severe CARDS developed bilateral pneumothorax with persistent air leak (PAL). Conservative management with prolonged chest tube drainage did not help in PAL resolution and both patients continued to be on high-end ventilatory support. The course was further complicated by the presence of septic shock. The 1st patient was taken up for a challenging procedure after spending 23 days on the mechanical ventilator. Diagnostic pleuroscopy revealed left-sided bullae and a surgical staple bullectomy was done. The right side showed a large bronchopleural fistula (BPF) on pleuroscopy, which was occluded using a customized endobronchial silicone blocker (CESB, described in 2018). This led to the reduction and finally, resolution of the bilateral PAL with subsequent removal of chest drains and weaning off the ventilator and oxygen. The second patient was managed with 2 CESB devices for occlusion of RUL anterior and posterior segment fistulae, followed by chest drain removal. These cases highlight effective out-of-the-box multimodality treatment using a combination of interventional pulmonary techniques and surgical stapling for a life-threatening bilateral PAL secondary to CARDS.
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Affiliation(s)
- Sameer Bansal
- Department of Pulmonary MedicineApollo HospitalsBangaloreIndia
| | - Arul Furtado
- Department of Cardiovascular & Thoracic SurgeryApollo HospitalsBangaloreIndia
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16
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Hattori M, Ohshimo S, Shime N. Is Pneumomediastinum Really an Independent Prognostic Factor for COVID-19 Pneumonia? Crit Care Med 2023; 51:e136-e137. [PMID: 37199560 DOI: 10.1097/ccm.0000000000005858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Miyuki Hattori
- All authors: Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Muley M, Finamore P, Pedone C, Margiotta DPE, Gilardi E, Sambuco F, De Vincentis A, Vespasiani-Gentilucci U, Travaglino F, Incalzi RA. The authors reply. Crit Care Med 2023; 51:e138-e139. [PMID: 37199561 DOI: 10.1097/ccm.0000000000005882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Moises Muley
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Panaiotis Finamore
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Claudio Pedone
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Emanuele Gilardi
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Federica Sambuco
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Antonio De Vincentis
- Internal Medicine Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Francesco Travaglino
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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18
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Ghenu MI, Manea MM, Timofte D, Balcangiu-Stroescu AE, Ionescu D, Tulin R, Ciornei MC, Dragoş D. Critical Damage of Lung Parenchyma Complicated with Massive Pneumothorax in COVID-19 Pneumonia. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231175644. [PMID: 37220587 PMCID: PMC10200706 DOI: 10.1177/11795476231175644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023]
Abstract
It is already known that Coronavirus disease 2019 (COVID-19) may lead to various degrees and forms of lung parenchyma damage, but some cases take a strikingly severe course that is difficult to manage. We report the case of a 62-year old male, non-obese, non-smoker, and non-diabetic, who presented with fever, chills, and shortness of breath. The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed by real-time Polymerase Chain Reaction. Although the patient had been vaccinated with 2 doses of Pfizer-BioNTech COVID-19 vaccine 7 months earlier and had no risk factors for a severe outcome, serial computed tomography (CT) scan revealed lung involvement progressively extending from an initial 30% to 40% to almost 100% 2.5 months later. The spectrum of lung lesions included at first only ground-glass opacities and some tiny emphysema bullae, but later also bronchiectasis, pulmonary fibrosis, and large emphysema bullae as post-COVID-19 pulmonary sequelae. For fear of severe evolution of superimposed bacterial infection (Clostridoides difficile enterocolits and possibly bacterial pneumonia) the administration of corticosteroids was intermittent. Massive right pneumothorax secondary to bulla rupture, possibly favored by the indispensable high flow oxygen therapy, led to respiratory failure compounded by hemodynamic instability, and ultimately to the patient's final demise. COVID-19 pneumonia may cause severe lung parenchyma damage which requires long-term supplemental oxygen therapy. Beneficial or even lifesaving as it might be, high flow oxygen therapy may nonetheless have deleterious effects too, including the development of bullae that may rupture engendering pneumothorax. Corticosteroid treatment should probably be pursued despite superimposed bacterial infection to limit the viral induced damage to lung parenchyma.
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Affiliation(s)
- Maria Iuliana Ghenu
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- 1st Internal Medicine Clinic,
University Emergency Hospital Bucharest, Bucharest, Romania
| | - Maria Mirabela Manea
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- National Institute of Neurology and
Cerebrovascular Diseases, Bucharest, Romania
| | - Delia Timofte
- Dialysis Department, University
Emergency Hospital Bucharest, Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- Dialysis Department, University
Emergency Hospital Bucharest, Bucharest, Romania
| | - Dorin Ionescu
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- Nephrology Clinic, University Emergency
Hospital Bucharest, Bucharest, Romania
| | - Raluca Tulin
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- Endocrinology Department, “Prof. Dr.
Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania
| | - Mariana Cătălina Ciornei
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- Gastroenterology Clinic, University
Emergency Hospital Bucharest, Romania
| | - Dorin Dragoş
- “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department
(MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology
Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM),
Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine,
Embryology Department (RT)]
- 1st Internal Medicine Clinic,
University Emergency Hospital Bucharest, Bucharest, Romania
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Zeng P, Lin Y, Chen Y, Tan G. Effects of incentive spirometry respiratory trainer device on lung recruitment in non-intubated mechanical ventilation moderate ARDS patients: A retrospective study. Heliyon 2023; 9:e16073. [PMID: 37206014 PMCID: PMC10189391 DOI: 10.1016/j.heliyon.2023.e16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives A retrospective study was performed to investigate the effects of incentive spirometry (IS)respiratory trainer device on lung recruitment in non-intubated moderate ARDS patients. Method Moderate ARDS patients who non-intubated from January 2019 to October 2022 were enrolled to the lung recruitment group and the control group. Compared the PaO2/FiO2 (P/F)ratio, lung ultrasound (LUS) score, APACHE-II score, Maximum inspiratory volume during three days (baseline, Day1, Day2, Day3) and the rate of intubation, mean hospital stay, the 28-day in-hospital mortality and the 90-days in-hospital mortality between the two groups. Results The lung recruitment group 118 patients (73 males, 47.6 ± 16.5y) and the control group 103 patients (62 males, 50.2 ± 14.8y) were included. The P/F ratios, APACHE-II scores, LUS scores, and the maximum inspiratory volume (ml) were significantly different between the two groups (P = 0.000, P = 0.014, P = 0.013 and P = 0.001, respectively).The P/F ratios were higher (252.6 ± 55.6 v.s, 166.96.9re, p = 0.035, day2), (269.8 ± 75.7 v.s 183.9 ± 68.6, p = 0.027, day3), the APACHE-II scores were lower (10.0 ± 2.4 v.s 15.3 1e l p = 0.025, day2), (8.0 ± 1.4 v.s 14.1 ± 2.7, p = 0.000, day3), the LUS scores were higher (16.2res wv.s 21.61.6w, p = 0.043, day2), (11.4 ± 5.9 v.s 20.3 ± 6.9, p = 0.004, day3), the maximum inspiratory volumes were higher (1722.3 ± 432.2 v.s 1310.70.732., p = 0.044, day2), (1913.5467.2 v.s 1299.79452.5, p = 0.018, day3) in Lung Recruitment group than that in Control group. These data at day1, day2, and day3 were significantly improvement than baseline in Lung Recruitment group. Only 36 patients (30.5%) in Lung Recruitment group needed to intubation, while 48 patients (46.6%) in Control group (p = 0.014). The mean hospital stay in lung recruitment group was lower (12.6 ± 4.6 v.s, 18.4 ± 5.3, P = 0.018). The 28-days and the 90-days in-hospital mortality were no statistical significance between the two groups (P = 0.414 and P = 0.418, respectively). Conclusions Using IS to perform lung recruitment in moderate ARDS patients can improve maximum inspiratory volume, PaO2/FiO2 ratio, LUS scores, and APACHE-II score and reduce the rate of intubation and the mean hospital stay, but the 28 days and the 90-days in-hospital mortality were not improved.
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Affiliation(s)
| | | | | | - Guoliang Tan
- Corresponding author. Department ICU of the Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, 362000, China.
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Bai Y, Li M, Chen S, Zhang Z, Huang X, Xia J, Zhan Q. Incidence, outcomes and risk factors of barotrauma in veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome. Respir Med 2023; 213:107248. [PMID: 37080477 DOI: 10.1016/j.rmed.2023.107248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Although acute respiratory distress syndrome (ARDS) patients are provided a lung rest strategy during extracorporeal membrane oxygenation (ECMO) treatment, the exact conditions of barotrauma is unclear. Therefore, we analyzed the epidemiology and risk factors for barotrauma in ARDS patients using ECMO in a single, large ECMO center in China. METHODS A retrospective analysis was performed on 127 patients with ARDS received veno-venous (VV) ECMO who met the Berlin definition. The epidemiology and risk factors for barotrauma during ECMO were analyzed. RESULTS Among 127 patients with ARDS treated with ECMO, barotrauma occurred in 24 (18.9%) during ECMO and 9 (7.1%) after ECMO decannulation, mainly in the late stage of ARDS (75%) and ≥8 days during ECMO (54.2%). Univariate and multivariate analyses showed that younger ARDS patients (OR = 0.953, 95%CI 0.923-0.983, p = 0.003) and those with pneumocystis jirovecii pneumonia (PJP) (OR = 3.15, 95%CI 1.070-9.271, p = 0.037), elevated body temperature after establishing ECMO (OR = 2.997, 95%CI 1.325-6.779, p = 0.008) and low platelet count after establishing ECMO (OR = 0.985, 95%CI 0.972-0.998, p = 0.02) had an increased risk of barotrauma during ECMO. There was no difference in ventilator parameters between patients with and without barotrauma. Barotrauma during ECMO was mainly related to the etiology of the disease and disease state. CONCLUSION There is a high incidence of barotrauma in ARDS patients during ECMO, even after ECMO decannulation. Young age, PJP, elevated body temperature and low platelet count after establishing ECMO are risk factors of barotrauma, and those patients should be closely monitored by imaging, especially in the late stage of ARDS.
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Affiliation(s)
- Yu Bai
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Min Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shengsong Chen
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zeyu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xu Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jingen Xia
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
| | - Qingyuan Zhan
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
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21
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Belletti A, Pallanch O, Bonizzoni MA, Guidi L, De Cobelli F, Landoni G, Zangrillo A, De Bonis M, Palumbo D. Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review. Respir Med 2023; 210:107178. [PMID: 36863617 DOI: 10.1016/j.rmed.2023.107178] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to further characterize the clinical role of Macklin. METHODS PubMed, Scopus, Cochrane Central Register and Embase were searched for studies reporting data on Macklin. Studies without data on chest CT, pediatric studies, non-human and cadaver studies, case reports and series including <5 patients were excluded. The primary objective was to assess the number of patients with Macklin sign and barotrauma. Secondary objectives were: occurrence of Macklin in different populations, clinical use of Macklin, prognostic impact of Macklin. RESULTS Seven studies enrolling 979 patients were included. Macklin was present in 4-22% of COVID-19 patients. It was associated with barotrauma in 124/138 (89.8%) of cases. Macklin sign preceded barotrauma in 65/69 cases (94.2%) 3-8 days in advance. Four studies used Macklin as pathophysiological explanation for barotrauma, two studies as a predictor of barotrauma and one as a decision-making tool. Two studies suggested that Macklin is a strong predictor of barotrauma in ARDS patients and one study used Macklin sign to candidate high-risk ARDS patients to awake extracorporeal membrane oxygenation (ECMO). A possible correlation between Macklin and worse prognosis was suggested in two studies on COVID-19 and blunt chest trauma. CONCLUSIONS Increasing evidence suggests that Macklin sign anticipate barotrauma in patients with ARDS and there are initial reports on use of Macklin as a decision-making tool. Further studies investigating the role of Macklin sign in ARDS are justified.
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Affiliation(s)
- Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavia Pallanch
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Aldo Bonizzoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Guidi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Goossen RL, Verboom M, Blacha M, Smesseim I, Beenen LFM, van Meenen DMP, Paulus F, Schultz MJ. Incidence of Air Leaks in Critically Ill Patients with Acute Hypoxemic Respiratory Failure Due to COVID-19. Diagnostics (Basel) 2023; 13:1156. [PMID: 36980464 PMCID: PMC10046975 DOI: 10.3390/diagnostics13061156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2-5) chest radiographs and a median of one (1-2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2-21) days after arrival in the ICU and 18 (9-22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.
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Affiliation(s)
- Robin L. Goossen
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Mariëlle Verboom
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Mariëlle Blacha
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Illaa Smesseim
- Department of Thoracic Oncology, Antoni van Leeuwenhoek Ziekenhuis, 1066 CX Amsterdam, The Netherlands
| | - Ludo F. M. Beenen
- Department of Radiology, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - David M. P. van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
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23
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Lee SJ, Kim J, Lee KH, Lee JA, Kim CH, Lee SH, Park BJ, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yeom JS, Choi JY. Risk factors of pneumothorax and pneumomediastinum in COVID-19: a matched case-control study. BMC Infect Dis 2023; 23:137. [PMID: 36882735 PMCID: PMC9990560 DOI: 10.1186/s12879-023-08104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND During the novel coronavirus disease-2019 pandemic, a considerable number of pneumothorax (PNX)/pneumomediastinum (PNM) associated with COVID-19 have been reported, and the incidence is higher in critically ill patients. Despite using a protective ventilation strategy, PNX/PNM still occurs in patients on invasive mechanical ventilation (IMV). This matched case-control study aims to identify the risk factors and clinical characteristics of PNX/PNM in COVID-19. METHODS This retrospective study enrolled adult patients with COVID-19, admitted to a critical care unit from March 1, 2020, to January 31, 2022. COVID-19 patients with PNX/PNM were compared, in a 1-2 ratio, to COVID-19 patients without PNX/PNM, matched for age, gender, and worst National Institute of Allergy and Infectious Diseases ordinal scale. Conditional logistic regression analysis was performed to assess the risk factors for PNX/PNM in COVID-19. RESULTS 427 patients with COVID-19 were admitted during the period, and 24 patients were diagnosed with PNX/PNM. Body mass index (BMI) was significantly lower in the case group (22.8 kg/m2 and 24.7 kg/m2; P = 0.048). BMI was statistically significant risk factor for PNX/PNM in univariate conditional logistic regression analysis [odds ratio (OR), 0.85; confidence interval (CI), 0.72-0.996; P = 0.044]. For patients on IMV support, univariate conditional logistic regression analysis showed the statistical significance of the duration from symptom onset to intubation (OR, 1.14; CI, 1.006-1.293; P = 0.041). CONCLUSIONS Higher BMI tended to show a protective effect against PNX/PNM due to COVID-19 and delayed application of IMV might be a contributive factor for this complication.
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Affiliation(s)
- Se Ju Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Jinnam Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hyun Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ah Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyup Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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24
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Ficial B, Whebell S, Taylor D, Fernández-Garda R, Okiror L, Meadows CIS. Bronchoscopic Endobronchial Valve Therapy for Persistent Air Leaks in COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation. J Clin Med 2023; 12:jcm12041348. [PMID: 36835885 PMCID: PMC9962378 DOI: 10.3390/jcm12041348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ventilation or extracorporeal membrane oxygenation (ECMO). We present a series of patients requiring veno-venous ECMO for COVID-19 ARDS who underwent endobronchial valve (EBV) management of PAL. This is a single-centre retrospective observational study. Data were collated from electronic health records. Patients treated with EBV met the following criteria: ECMO for COVID-19 ARDS; the presence of BPF causing PAL; air leak refractory to conventional management preventing ECMO and ventilator weaning. Between March 2020 and March 2022, 10 out of 152 patients requiring ECMO for COVID-19 developed refractory PALs, which were successfully treated with bronchoscopic EBV placement. The mean age was 38.3 years, 60% were male, and half had no prior co-morbidities. The average duration of air leaks prior to EBV deployment was 18 days. EBV placement resulted in the immediate cessation of air leaks in all patients with no peri-procedural complications. Weaning of ECMO, successful ventilator recruitment and removal of pleural drains were subsequently possible. A total of 80% of patients survived to hospital discharge and follow-up. Two patients died from multi-organ failure unrelated to EBV use. This case series presents the feasibility of EBV placement in severe parenchymal lung disease with PAL in patients requiring ECMO for COVID-19 ARDS and its potential to expedite weaning from both ECMO and mechanical ventilation, recovery from respiratory failure and ICU/hospital discharge.
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Affiliation(s)
- Barbara Ficial
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Stephen Whebell
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Intensive Care Unit, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Daniel Taylor
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Rita Fernández-Garda
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Christopher I. S. Meadows
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Correspondence:
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Whitney J, Keir I. Clinical review of high-flow nasal oxygen therapy in human and veterinary patients. Front Vet Sci 2023; 10:1070881. [PMID: 36950541 PMCID: PMC10027015 DOI: 10.3389/fvets.2023.1070881] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.
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Sharma S, Badami V, Rojas E, Sangani R, Chapman K, Avalon C, King A, Wen S. High incidence of barotrauma in patients admitted with COVID-19 to ICU and associated mortality in rural Appalachia: An observational study. PLoS One 2023; 18:e0282735. [PMID: 36893088 PMCID: PMC9997869 DOI: 10.1371/journal.pone.0282735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES To assess the incidence of barotrauma and its impact on mortality in COVID-19 patients admitted to ICU. DESIGN Single-center retrospective study of consecutive COVID-19 patients admitted to a rural tertiary-care ICU. The primary outcomes were incidence of barotrauma in COVID-19 patients and all-cause 30-day mortality. Secondary outcomes were the length of stay (LOS) in the hospital and ICU. Kaplan-Meier method and log-rank test were used in the survival data analysis. SETTING Medical ICU, West Virginia University Hospital (WVUH), USA. PATIENTS All adult patients were admitted to the ICU for acute hypoxic respiratory failure due to coronavirus disease 2019 between September 1, 2020, and December 31, 2020. Historical controls were ARDS patients admitted pre-COVID. INTERVENTION Not applicable. MEASUREMENTS AND MAIN RESULTS One hundred and sixty-five consecutive patients with COVID-19 were admitted to the ICU during the defined period, compared to 39 historical non-COVID controls. The overall incidence of barotrauma in COVID-19 patients was 37/165 (22.4%) compared to 4/39 (10.3%) in the control group. Patients with COVID-19 and barotrauma had a significantly worse survival (HR = 1.56, p = 0.047) compared to controls. In those requiring invasive mechanical ventilation, the COVID group also had significantly higher rates of barotrauma (OR 3.1, p = 0.03) and worse all-cause mortality (OR 2.21, p = 0.018). COVID-19 with barotrauma had significantly higher LOS in the ICU and the hospital. CONCLUSIONS Our data on critically ill COVID-19 patients admitted to the ICU shows a high incidence of barotrauma and mortality compared to the controls. Additionally, we report a high incidence of barotrauma even in non-ventilated ICU patients.
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Affiliation(s)
- Sunil Sharma
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
- * E-mail:
| | - Varun Badami
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Edward Rojas
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Rahul Sangani
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Kyle Chapman
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Carlo Avalon
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Austin King
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States of America
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Kelebeyev S, Davison W, Ford BL, Pitman MJ, Bulman WA. The Effects of Endotracheal Tube Size During Bronchoscopy in Simulated Models of Intubated Patients. Laryngoscope 2023; 133:147-153. [PMID: 35218022 DOI: 10.1002/lary.30074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim is to use a simulation lung model to assess the possibility of performing bronchoscopy through endotracheal tubes (ETT) less than 8.0-mm while appropriately ventilating patients with normal and ARDS lungs in the setting of SARS-CoV-2. METHODS Five SHERIDAN® ETTs were used to ventilate SimMan® 3G under respiratory compliance levels representing normal and severe ARDS lungs. Baseline measurements of peak pressure, plateau pressure, and auto-positive end expiratory pressure (auto-PEEP) were recorded at four different inspiratory times (Ti). Three different-sized disposable bronchoscopes were inserted, and all measurements were repeated. RESULTS Normal lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures <30 cm H2 O, and increasing Ti to minimize peak pressure resulted in low auto-PEEP. Regular bronchoscopes in 7.0-mm ETTs had similar results. Large bronchoscopes in 7.5-mm ETTs generated plateau pressures ranging from 28 to 35 cm H2 O with modest auto-PEEP. Severe ARDS lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures of 46 and an auto-PEEP of 5 cm H2 O. Regular bronchoscopes in 7.0-mm ETTs generated similar results. Large bronchoscopes in 8.0-mm ETTs displayed plateau pressures of 44 and an auto-PEEP of 2 cm H2 O. CONCLUSION To mitigate risk of laryngeal injury, larger ETTs during bronchoscopy should be avoided. Our data show bronchoscopy with any ETT causes auto-PEEP and high plateau pressures, especially in lungs with poor compliance; however, ETT less than 7.5 mm can be used when considering several factors. Our data also suggest similar studies in patients with varying degrees of ARDS would be informative. LEVEL OF EVIDENCE NA Laryngoscope, 133:147-153, 2023.
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Affiliation(s)
- Saveliy Kelebeyev
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Wesley Davison
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - Branden L Ford
- Mary & Michael Jaharis Simulation Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - William A Bulman
- Department of Medicine - Division of Pulmonary, Allergy and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
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Time dependency and unique etiology of barotrauma in COVID-19: A retrospective cohort study with landmark analysis and pathological approach. PLoS One 2023; 18:e0282868. [PMID: 36921007 PMCID: PMC10016681 DOI: 10.1371/journal.pone.0282868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Barotrauma frequently occurs in coronavirus disease 2019. Previous studies have reported barotrauma to be a mortality-risk factor; however, its time-dependent nature and pathophysiology are not elucidated. To investigate the time-dependent characteristics and the etiology of coronavirus disease 2019-related-barotrauma. METHODS AND FINDINGS We retrospectively reviewed intubated patients with coronavirus disease 2019 from March 2020 to May 2021. We compared the 90-day survival between the barotrauma and non-barotrauma groups and performed landmark analyses on days 7, 14, 21, and 28. Barotrauma within seven days before the landmark was defined as the exposure. Additionally, we evaluated surgically treated cases of coronavirus disease 2019-related pneumothorax. We included 192 patients. Barotrauma developed in 44 patients (22.9%). The barotrauma group's 90-day survival rate was significantly worse (47.7% vs. 82.4%, p < 0.001). In the 7-day landmark analysis, there was no significant difference (75.0% vs. 75.7%, p = 0.79). Contrastingly, in the 14-, 21-, and 28-day landmark analyses, the barotrauma group's survival rates were significantly worse (14-day: 41.7% vs. 69.1%, p = 0.044; 21-day: 16.7% vs. 62.5%, p = 0.014; 28-day: 20.0% vs. 66.7%, p = 0.018). Pathological examination revealed a subpleural hematoma and pulmonary cyst with heterogenous lung inflammation. CONCLUSIONS Barotrauma was a poor prognostic factor for coronavirus disease 2019, especially in the late phase. Heterogenous inflammation may be a key finding in its mechanism. Barotrauma is a potentially important sign of lung destruction.
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Donohue KN, Sivanushanthan S, Etling E, Hockstein M, Yohannes S, Clark P. Incidence of barotrauma in patients with COVID-19 (alpha- and beta-predominant period) requiring mechanical ventilation: Single-center retrospective study. SAGE Open Med 2023; 11:20503121231159479. [PMID: 36941897 PMCID: PMC10020859 DOI: 10.1177/20503121231159479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
Objective We sought to determine predictors, incidence, and interventions required for patients who developed barotrauma. Pneumothorax, subcutaneous emphysema, and pneumomediastinum have all been reported as complications related to COVID-19-positive patients requiring invasive mechanical ventilation. Methods In this retrospective study, clinical and imaging data from COVID-19 patients were collected and reviewed by two independent intensivists between January 4, 2020 and January 10, 2020. Data were used to identify COVID-19-positive patients requiring invasive mechanical ventilation and the incidence of barotrauma. Two separate cohorts were created as non-injured (no barotrauma) and injured (barotrauma present). We then sought to identify the risk factors for barotrauma in the non-injured cohort on Days 0, 7, 10, and 14 after intubation and day of injury in the injured cohort. Results Of the 264 patients with COVID-19, 55.8% were African American. The non-injured group was older (60 ± 15 versus 49 ± 16, p = 0.006), with male predominance in the injured group versus non-injured group (75% versus 55%). A total of 16 (6.5%) patients developed one or more complications of barotrauma, defined as subcutaneous emphysema, pneumothorax, or pneumomediastinum. Length of stay was longer for the injured group versus non-injured group (47 versus 25 days). Plateau pressure (p = 0.024), fraction of inspired oxygen (p < 0.001), and driving pressure (p = 0.001) were statistically significant in injured cohort. Mortality rate in non-injured versus injured was 49.4% versus 69%. Using random effect model, fraction of inspired oxygen (p = 0.003) and mean airway pressure (p = 0.010) were significant at the time of injury. When comparing alive versus deceased in the injured cohort, thoracostomy placement in alive versus deceased was 80% versus 54.5%. Conclusion COVID acute respiratory distress syndrome patients requiring invasive mechanical ventilation had a higher rate of barotrauma and were younger than those who did not develop barotrauma. Possible interventions to be considered to decrease barotrauma are decreased driving pressure goal and universal use of esophageal balloon manometry.
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Affiliation(s)
| | | | - Emily Etling
- Georgetown University School of
Medicine, Washington, DC, USA
| | - Michael Hockstein
- Department of Critical Care, MedStar
Washington Hospital Center, Washington, DC, USA
| | - Seife Yohannes
- Department of Critical Care, MedStar
Washington Hospital Center, Washington, DC, USA
| | - Paul Clark
- Department of Critical Care, MedStar
Washington Hospital Center, Washington, DC, USA
- Paul Clark, Department of Critical Care,
Medstar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA.
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Bay P, de Chambrun MP, Rothstein V, Mahevas M, De Prost N, Roux A, Zuber B, Biet DI, Hervier B, Tazi A, Mouthon L, Mekinian A, Deligny C, Borie R, Meurice JC, Meyer A, Priou P, Savale L, De Saint Martin L, Gallay L, Cottin V, Blanchard E, Brillet PY, Khafagy P, Benveniste O, Nunes H, Allenbach Y, Uzunhan Y. Efficacy of plasma exchange in patients with anti-MDA5 rapidly progressive interstitial lung disease. J Autoimmun 2022; 133:102941. [PMID: 36323067 DOI: 10.1016/j.jaut.2022.102941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rapidly progressive interstitial lung disease (RP-ILD) is a frequent and severe manifestation of anti-MDA5 dermatomyositis (MDA5-DM) associated with poor outcome. The optimal treatment regimen for MDA5-DM RP-ILD is yet to be determined. Specifically, the value of adding plasma exchange (PLEX) to corticosteroids and immunosuppressants remains unclear. We aimed to evaluate the effect of PLEX on the outcome of patients with MDA5-DM RP-ILD. METHODS This French nationwide multicentre retrospective study included all MDA5-DM RP-ILD patients from 2012 to 2021 admitted to 18 centres. The primary endpoint was one-year transplant-free survival. RESULTS 51 patients with MDA5-DM RP-ILD (female 67%; mean age at disease onset: 51 ± 11.6 years) were included. Thirty-two (63%) patients required mechanical ventilation and twenty-five (49%) received PLEX. One-year mortality or lung transplant occurred in 63% cases after a median follow-up of 77 [38-264] days. The Cox proportional hazards multivariable model only retained mechanical ventilation but not PLEX (p = 0.7) as independent predictor of the primary endpoint. One-year transplant-free survival rates in PLEX + vs. PLEX-were 20% vs. 54% (p = 0.01), respectively. The Kaplan-Meier estimated probabilities of one-year transplant-free survival was statistically higher in PLEX-compared to PLEX + patients (p = 0.05). PLEX + compared to PLEX-patients more frequently received mechanical ventilation and immunosuppressants suggesting PLEX + patients had a more severe disease. CONCLUSION MDA5-DM RP-ILD is associated with poor rate of one-year transplant-free survival. The use of PLEX was not associated with a better outcome albeit they were mainly given to more severe patients. While our study reports the largest series of MDA5-DM RP-ILD given PLEX, these results needs to be interpreted with caution owing the numerous selection, indication and interpretation bias. Further studies are needed to evaluate their efficacy in this setting.
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Affiliation(s)
- Pierre Bay
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Paris, France
| | - Vincent Rothstein
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université de Paris, Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Matthieu Mahevas
- Université Paris-Est Créteil, Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas De Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Antoine Roux
- Service de Pneumologie, Hôpital Foch, Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Benjamin Zuber
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | | | - Baptiste Hervier
- Université de Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service de Médecine Interne, Paris, France; Inserm UMR-S 976, "HIPI", Hopital Saint-Louis & Université Paris Cité, France
| | - Abdellatif Tazi
- Service de Pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Arsène Mekinian
- DMU I3, Sorbonne Université, Service de Médecine Interne, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Raphaël Borie
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Pneumologie A, Paris, France
| | | | - Alain Meyer
- Département de Physiologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pascaline Priou
- Département de Pneumologie, Centre Hospitalier Universitaire D'Angers, Angers, France
| | - Laurent Savale
- Department Service de Pneumologie et Unité de Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Laure Gallay
- Hospices Civils de Lyon, Médecine Interne, Hôpital Edouard Herriot, Lyon, France; Université de Lyon, France
| | - Vincent Cottin
- Centre National de Référence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Elodie Blanchard
- Service des Maladies Respiratoires,CHU Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pierre-Yves Brillet
- Service de Radiologie, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Philippe Khafagy
- Service de Radiologie, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Olivier Benveniste
- Centre de Recherche en Myologie, Unité Mixte de Recherche Scientifique 974, Université Pierre et Marie Curie, INSERM, France; Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, DHUi2B, Paris, France
| | - Hilario Nunes
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, France
| | - Yves Allenbach
- Centre de Recherche en Myologie, Unité Mixte de Recherche Scientifique 974, Université Pierre et Marie Curie, INSERM, France; Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, DHUi2B, Paris, France
| | - Yurdagül Uzunhan
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, France
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Abstract
Radiology plays an important role in the management of the most seriously ill patients in the hospital. Over the years, continued advances in imaging technology have contributed to an improvement in patient care. However, even with such advances, the portable chest radiograph (CXR) remains one of the most commonly requested radiographic examinations. While they provide valuable information, CXRs remain relatively insensitive at revealing abnormalities and are often nonspecific. Chest computed tomography (CT) can display findings that are occult on CXR and is particularly useful at identifying and characterizing pleural effusions, detecting barotrauma including small pneumothoraces, distinguishing pneumonia from atelectasis, and revealing unsuspected or additional abnormalities which could result in increased morbidity and mortality if left untreated. CT pulmonary angiography is the modality of choice in the evaluation of pulmonary emboli which can complicate the hospital course of the ICU patient. This article will provide guidance for interpretation of CXR and thoracic CT images, discuss some of the invasive devices routinely used, and review the radiologic manifestations of common pathologic disease states encountered in ICU patients. In addition, imaging findings and complications of more specific clinical scenarios in which the incidence has increased in the ICU setting, such as patients who are immunocompromised, have interstitial lung disease, or COVID-19, will also be discussed. Communication between the radiologist and intensivist, particularly on complicated cases, is important to help increase diagnostic accuracy and leads to an improvement in the management of the most critically ill patients.
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Affiliation(s)
- Dennis Toy
- Department of Medical Imaging, Colorado Permanente Medical Group, Lafayette, Colorado
| | - Mark D Siegel
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ami N Rubinowitz
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Elabbadi A, Urbina T, Berti E, Contou D, Plantefève G, Soulier Q, Milon A, Carteaux G, Voiriot G, Fartoukh M, Gibelin A. Spontaneous pneumomediastinum: a surrogate of P-SILI in critically ill COVID-19 patients. Crit Care 2022; 26:350. [PMID: 36371306 PMCID: PMC9652578 DOI: 10.1186/s13054-022-04228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous pneumomediastinum (SP) has been described early during the COVID-19 pandemic in large series of patients with severe pneumonia, but most patients were receiving invasive mechanical ventilation (IMV) at the time of SP diagnosis. In this retrospective multicenter observational study, we aimed at describing the prevalence and outcomes of SP during severe COVID-19 with pneumonia before any IMV, to rule out mechanisms induced by IMV in the development of pneumomediastinum.Among 549 patients, 21 patients (4%) developed a SP while receiving non-invasive respiratory support, after a median of 6 days [4-12] from ICU admission. The proportion of patients requiring IMV was similar. However, the time to tracheal intubation was longer in patients with SP (6 days [5-13] vs. 2 days [1-4]; P = 0.00002), with a higher first-line use of non-invasive ventilation (n = 11; 52% vs. n = 150; 28%; P = 0.02). The 21 patients who developed a SP had persisting signs of severe lung disease and respiratory failure with lower ROX index between ICU admission and occurrence of SP (3.94 [3.15-5.55] at admission vs. 3.25 [2.73-4.02] the day preceding SP; P = 0.1), which may underline potential indirect signals of Patient-self inflicted lung injury (P-SILI).In this series of critically ill COVID-19 patients, the prevalence of SP without IMV was not uncommon, affecting 4% of patients. They received more often vasopressors and had a longer ICU length of stay, as compared with their counterparts. One pathophysiological mechanism may potentially be carried out by P-SILI related to a prolonged respiratory failure, as underlined by a delayed use of IMV and the evolution of the ROX index between ICU admission and the day preceding SP.
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Affiliation(s)
- Alexandre Elabbadi
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Tomas Urbina
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Enora Berti
- grid.412116.10000 0001 2292 1474Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Damien Contou
- grid.414474.60000 0004 0639 3263Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Gaëtan Plantefève
- grid.414474.60000 0004 0639 3263Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Quintana Soulier
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Audrey Milon
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Radiologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Guillaume Carteaux
- grid.412116.10000 0001 2292 1474Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Guillaume Voiriot
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Muriel Fartoukh
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Aude Gibelin
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
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Ma L, Yin M, Yang XL, Xu W. Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units. Eur J Med Res 2022; 27:218. [DOI: 10.1186/s40001-022-00858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
This study aimed to investigate air leakage during invasive mechanical ventilation (IMV) in a pediatric intensive care unit (PICU) and explore potential risk factors.
Methods
We conducted a retrospective cohort study of children who underwent IMV in a single-center PICU in a tertiary referral hospital. Air leakage risk factors and factors associated with an improved outcome were assessed.
Results
A total of 548 children who underwent IMV were enrolled in this study. Air leakage occurred in 7.5% (41/548) of the cases in the PICU. Air leakage increased the duration of IMV and hospitalization time. Multivariate logistic regression analysis showed a higher risk of air leakage during IMV for PICU patients with acute respiratory dyspnea syndrome (ARDS) (OR = 4.38), a higher pediatric critical illness score (PCIS) (OR = 1.08), or a higher peak inspiratory pressure (PIP) (OR = 1.08), whereas the risk was lower for patients with central respiratory failure (OR = 0.14). The logistic model had excellent predictive power for air leakage, with an area under the curve of 0.883 and tenfold cross-validation. Patients aged between 1 and 6 years who were diagnosed with measles or pneumonia and had a low positive end-expiratory pressure (PEEP) or high PaO2/FiO2 ratio were associated with improved outcomes. Patients diagnosed with central respiratory failure or congenital heart diseases were associated with less desirable outcomes.
Conclusions
Patients with ARDS, a higher PCIS at admission or a higher PIP were at higher risk of air leakage.
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Steinberger S, Finkelstein M, Pagano A, Manna S, Toussie D, Chung M, Bernheim A, Concepcion J, Gupta S, Eber C, Dua S, Jacobi AH. Barotrauma in COVID 19: Incidence, pathophysiology, and effect on prognosis. Clin Imaging 2022; 90:71-77. [PMID: 35926316 PMCID: PMC9238026 DOI: 10.1016/j.clinimag.2022.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
Objectives To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To describe the chest radiography patterns of barotrauma and understand the development in relation to mechanical ventilation and patient mortality. Methods We performed a retrospective study of 363 patients with COVID-19 from March 1 to April 8, 2020. Primary outcomes were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. The secondary outcomes were length of intubation and death. In patients with pneumomediastinum and/or subcutaneous emphysema, we conducted an imaging review to determine the timeline of barotrauma development. Results Forty three out of 363 (12%) patients developed barotrauma radiographically. The median time to development of either pneumomediastinum or subcutaneous emphysema was 2 days (IQR 1.0–4.5) after intubation and the median time to pneumothorax was 7 days (IQR 2.0–10.0). The overall incidence of pneumothorax was 28/363 (8%) with an incidence of 17/43 (40%) in the barotrauma cohort and 11/320 (3%) in those without barotrauma (p ≤ 0.001). In total, 257/363 (71%) patients died with an increase in mortality in those with barotrauma 33/43 (77%) vs. 224/320 (70%). When adjusting for covariates, barotrauma was associated with increased odds of death (OR 2.99, 95% CI 1.25–7.17). Conclusion Barotrauma is a frequent complication of mechanically ventilated COVID-19 patients. In comparison to intubated COVID-19 patients without barotrauma, there is a higher rate of pneumothorax and an increased risk of death.
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Incidence and risk factors of COVID-19 associated pneumothorax. PLoS One 2022; 17:e0271964. [PMID: 35930528 PMCID: PMC9355189 DOI: 10.1371/journal.pone.0271964] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023] Open
Abstract
Background Pneumothorax has been increasingly observed among patients with coronavirus disease-2019 (COVID-19) pneumonia, specifically in those patients who develop acute respiratory distress syndrome (ARDS). In this study, we sought to determine the incidence and potential risk factors of pneumothorax in critically ill adults with COVID-19. Method This retrospective cohort study included adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to one of the adult intensive care units of a tertiary, academic teaching hospital from May 2020 through May 2021. Results Among 334 COVID-19 cases requiring ICU admission, the incidence of pneumothorax was 10% (33 patients). Patients who experienced pneumothorax more frequently required vasopressor support (28/33 [84%] vs. 191/301 [63%] P = 0.04), were more likely to be proned (25/33 [75%] vs. 111/301 [36%], P<0.001), and the presence of pneumothorax was associated with prolonged duration of mechanical ventilation; 21 (1–97) versus 7 (1–79) days, p<0.001 as well as prolonged hospital length of stay (29 [9–133] vs. 15 [1–90] days, P<0.001), but mortality was not significantly different between groups. Importantly, when we performed a Cox proportional hazard ratio (HR) model of multivariate parameters, we found that administration of tocilizumab significantly increased the risk of developing pneumothorax (HR = 10.7; CI [3.6–32], P<0.001). Conclusion Among 334 critically ill patients with COVID-19, the incidence of pneumothorax was 10%. Presence of pneumothorax was associated with prolonged duration of mechanical ventilation and length of hospital stay. Strikingly, receipt of tocilizumab was associated with an increased risk of developing pneumothorax.
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Nishi K, Ogura M, Tamai N, Gima N, Ide K, Koinuma G, Kamei K, Ito S. Successful rituximab treatment for severe rapidly progressive interstitial lung disease with anti-MDA5 antibody-positive juvenile dermatomyositis: a case report and literature review. Pediatr Rheumatol Online J 2022; 20:60. [PMID: 35927666 PMCID: PMC9351133 DOI: 10.1186/s12969-022-00723-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rapidly progressive (RP) interstitial lung disease (ILD) is a life-threatening complication of juvenile dermatomyositis (JDM); however, it is generally refractory to treatment; to the best of our knowledge, no evidence-based treatment has been established for RP-ILD yet. We present the case of a 2-year-old girl with RP-ILD who showed resistance to treatment with methylprednisolone, cyclosporine A, cyclophosphamide, immunoglobulin, and plasma exchange (PE) and was finally treated with extracorporeal membrane oxygenation. We further present a literature review of 18 cases of JDM with RP-ILD. CASE PRESENTATION A 2-year-old girl presented with malar rash, mild muscle weakness, and weight loss for a few months before admission. She had a history of dry cough and dyspnea for a few days, followed by rapid respiratory failure. The patient was diagnosed with JDM with RP-ILD through physical examination (malar rashes and Gottron's sign) and based on the finding of myositis on femoral magnetic resonance imaging, elevated levels of serum muscle enzymes, positive anti-melanoma differentiation-association gene 5 (MDA5) antibody (> 7,500 index), elevated level of Krebs von den Lungen-6 glycoprotein (KL-6; 3,420 U/mL), and extensive ground-glass opacities with consolidation in the bilateral lungs on chest high-resolution computed tomography. She received combination therapy, including methylprednisolone pulse therapy, followed by oral prednisolone and intravenous cyclosporine A, cyclophosphamide, and immunoglobulin. On day 11 of hospitalization, she was placed on ventilation support and PE was initiated. However, her respiratory condition continued to deteriorate and veno-venous extracorporeal membrane oxygenation was started on day 24 of hospitalization. Rituximab was administered on day 28. After 2 weeks of rituximab therapy initiation, her respiratory condition showed gradual improvements. Eventually, on day 52 of hospitalization, the patient could be weaned off extracorporeal membrane oxygenation. Finally, she was discharged with minimal ventilation support and no neurological complications 11 months after admission. CONCLUSIONS Our literature review suggest that JDM with RP-ILD has a high mortality rate. In JDM, rituximab may be a promising treatment option for RP-ILD. In the future, the efficacy of rituximab in the early phases of ILD should be investigated.
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Affiliation(s)
- Kentaro Nishi
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naotaka Tamai
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Naofumi Gima
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Goro Koinuma
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. .,Department of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Kanagawa, 236-0004, Yokohama, Japan.
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Complications of invasive mechanical ventilation in critically Ill Covid-19 patients - A narrative review. Ann Med Surg (Lond) 2022; 80:104201. [PMID: 35874936 PMCID: PMC9287581 DOI: 10.1016/j.amsu.2022.104201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 01/08/2023] Open
Abstract
Critically ill COVID-19 patients have to undergo positive pressure ventilation, a non-physiological and invasive intervention that can be lifesaving in severe ARDS. Similar to any other intervention, it has its pros and cons. Despite following Lung Protective Ventilation (LPV), some of the complications are frequently reported in these critically ill patients and significantly impact overall mortality. The complications related to invasive mechanical ventilation (IMV) in critically ill COVID-19 patients can be broadly divided into pulmonary and non-pulmonary. Among pulmonary complications, the most frequent is ventilator-associated pneumonia. Others are barotrauma, including subcutaneous emphysema, pneumomediastinum, pneumothorax, bullous lesions, cardiopulmonary effects of right ventricular dysfunction, and pulmonary complications mimicking cardiac failure, including pulmonary edema. Tracheal complications, including full-thickness tracheal lesions (FTTLs) and tracheoesophageal fistulas (TEFs) are serious but rare complications. Non-Pulmonary complications include neurological, nephrological, ocular, and oral complications. The complications related to IMV in critically ill covid 19 patients can be broadly divided into pulmonary and non-pulmonary complications. Among pulmonary complications the most frequent is Ventilator associated pneumonia. Others are Barotrauma, Cardiopulmonary effects of right ventricular dysfunction & Pulmonary complications mimicking cardiac failure including pulmonary edema, tracheal complications including full thickness tracheal lesions & tracheoesophageal fistulas. Non-Pulmonary complications of prolonged IMV include neurological, nephrological, ocular and oral complications.
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Andrews P, Shiber J, Madden M, Nieman GF, Camporota L, Habashi NM. Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal. Front Physiol 2022; 13:928562. [PMID: 35957991 PMCID: PMC9358044 DOI: 10.3389/fphys.2022.928562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 12/16/2022] Open
Abstract
In the pursuit of science, competitive ideas and debate are necessary means to attain knowledge and expose our ignorance. To quote Murray Gell-Mann (1969 Nobel Prize laureate in Physics): "Scientific orthodoxy kills truth". In mechanical ventilation, the goal is to provide the best approach to support patients with respiratory failure until the underlying disease resolves, while minimizing iatrogenic damage. This compromise characterizes the philosophy behind the concept of "lung protective" ventilation. Unfortunately, inadequacies of the current conceptual model-that focuses exclusively on a nominal value of low tidal volume and promotes shrinking of the "baby lung" - is reflected in the high mortality rate of patients with moderate and severe acute respiratory distress syndrome. These data call for exploration and investigation of competitive models evaluated thoroughly through a scientific process. Airway Pressure Release Ventilation (APRV) is one of the most studied yet controversial modes of mechanical ventilation that shows promise in experimental and clinical data. Over the last 3 decades APRV has evolved from a rescue strategy to a preemptive lung injury prevention approach with potential to stabilize the lung and restore alveolar homogeneity. However, several obstacles have so far impeded the evaluation of APRV's clinical efficacy in large, randomized trials. For instance, there is no universally accepted standardized method of setting APRV and thus, it is not established whether its effects on clinical outcomes are due to the ventilator mode per se or the method applied. In addition, one distinctive issue that hinders proper scientific evaluation of APRV is the ubiquitous presence of myths and misconceptions repeatedly presented in the literature. In this review we discuss some of these misleading notions and present data to advance scientific discourse around the uses and misuses of APRV in the current literature.
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Affiliation(s)
- Penny Andrews
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joseph Shiber
- University of Florida College of Medicine, Jacksonville, FL, United States
| | - Maria Madden
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gary F. Nieman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Luigi Camporota
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, United Kingdom
| | - Nader M. Habashi
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
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ÖZKUL B, URFALI FE, ASİL K. Quantitative Evaluation of Lung Parenchyma Changes after Treatment in COVID-19 Pneumonia with Volumetric Study in Computed Tomography. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1136688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective
COVID-19 pandemic, causing approximately 3 million deaths over worldwide, still continues. Effect of COVID-19 pneumonia after treatment on the lungs still not know. Although widely using computed tomography (CT) for diagnosing COVID-19 pneumonia, there is not enough study to determine damage of lung after treatment in COVID-19 pneumonia. In this study, our aim was to evaluate lung parenchyma changes in COVID-19 pneumonia after treatment with volumetric study, quantitatively.
Methods
25 patients, who has CT at the time of diagnosis (CT1) and after 282 days (CT2), and positive polymerase chain reaction test, were included in this retrospective single center study. Total lung volüme (TLV) and emphysematous lung (ELV) volume of CT1 and CT2 were calculated automatically by using Myrian® XP-Lung and Percentage of emphysematous area (PEA) was calculated by dividing ELV by TLV. Differences between CT1 and CT2 in PEA and in TLV and ELV was determined by Wilcoxon and Paired sample t test, respectively.
Results
Although higher TLV was found in CT2 (4216,43 ± 1048,99 cm3) than CT1 (3943,22 ± 1177,16 cm3), there was no statistical significance difference (p=0.052) between CT1 and CT2. ELV was statistically (p=0.017) higher in CT2 (937,22 ± 486,89 cm3) than CT1 (716,26 ± 471,65 cm3). There was a strong indication that the medians were significantly different in PEA (p=0,009).
Conclusions
Our study showed that there were emphysematous changes in lung parenchyma after COVID-19 pneumonia with CT, quantitatively and in our knowledge, this is the first study that evaluating lung changes quantitative after COVID-19 pneumonia.
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Melhorn J, Achaiah A, Conway FM, Thompson EMF, Skyllberg EW, Durrant J, Hasan NA, Madani Y, Naran P, Vijayakumar B, Tate MJ, Trevelyan GE, Zaki I, Doig CA, Lynch G, Warwick G, Aujayeb A, Jackson KA, Iftikhar H, Noble JH, Ng AYKC, Nugent M, Evans PJ, Hastings RA, Bellenberg HR, Lawrence H, Saville RL, Johl NT, Grey AN, Ellis HC, Chen C, Jones TL, Maddekar N, Khan SL, Muhammad AI, Ghani H, Myint YMM, Rafique C, Pippard BJ, Irving BRH, Ali F, Asimba VH, Azam A, Barton EC, Bhatnagar M, Blackburn MP, Millington KJ, Budhram NJ, Bunclark KL, Sapkal TP, Dixon G, Harries AJE, Ijaz M, Karunanithi V, Naik S, Khan MA, Savlani K, Kumar V, Gallego BL, Mahdi NA, Morgan C, Patel N, Rowlands EW, Steward MS, Thorley RS, Wollerton RL, Ullah S, Smith DM, Lason W, Rostron AJ, Rahman NM, Hallifax RJ. Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey. Eur Respir J 2022; 60:2102522. [PMID: 35144988 PMCID: PMC8832377 DOI: 10.1183/13993003.02522-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/12/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome. METHODS A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality. RESULTS 377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality. CONCLUSIONS Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.
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Affiliation(s)
- James Melhorn
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- JM is the guarantor and takes responsibility for the integrity of the work from inception to published article
| | - Andrew Achaiah
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, UK
| | | | | | | | - Joseph Durrant
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Neda A Hasan
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Yasser Madani
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Prasheena Naran
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Bavithra Vijayakumar
- Royal Brompton Hospital, National Heart and Lung Institute, London, UK
- Chelsea and Westminster Hospital, National Heart and Lung Institute, Imperial College London, UK
| | - Matthew J Tate
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Gareth E Trevelyan
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Irfan Zaki
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Catherine A Doig
- Southend University Hospital, Mid and South Essex NHS Foundation Trust, Southend, UK
| | - Geraldine Lynch
- Prince of Wales Hospital, Cwm Taf Morgannwg University Health Board, Bridgend, Wales, UK
| | - Gill Warwick
- The Royal Gwent Hospital, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Karl A Jackson
- Northumbria Specialist Emergency Care Hospital, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Hina Iftikhar
- Gloucester Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jonathan H Noble
- Gloucester Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Anthony Y K C Ng
- Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mark Nugent
- Glangwilli General Hospital, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Philip J Evans
- Glangwilli General Hospital, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Robert A Hastings
- Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Harry R Bellenberg
- Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hannah Lawrence
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rachel L Saville
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nikolas T Johl
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Adam N Grey
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Huw C Ellis
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Stoke Mandeville, UK
| | - Cheng Chen
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Stoke Mandeville, UK
| | - Thomas L Jones
- Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Nadeem Maddekar
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | - Shahul Leyakathali Khan
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | | | - Hakim Ghani
- Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Cecillia Rafique
- University Hospital of North Tees, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Benjamin J Pippard
- University Hospital of North Tees, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Benjamin R H Irving
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Fawad Ali
- Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Viola H Asimba
- Nottingham University Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aqeem Azam
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Eleanor C Barton
- The Grange University Hospital, Aneurin Bevan Health Board, Cwmbran, Wales, UK
| | - Malvika Bhatnagar
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Matthew P Blackburn
- Southport and Ormskirk District General Hospital, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Kate J Millington
- Great Western Hospital, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Nicholas J Budhram
- Great Western Hospital, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Katherine L Bunclark
- Norwich and Norfolk University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Toshit P Sapkal
- Norwich and Norfolk University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Giles Dixon
- Royal United Hospitals Bath, The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Andrew J E Harries
- Royal Glamorgan Hospital, Llantrisant, Cwm Taf University Health Board, Wales, UK
| | - Mohammad Ijaz
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Samir Naik
- The Princess Alexandra Hospital, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Malik Aamaz Khan
- Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Karishma Savlani
- Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Vimal Kumar
- Kettering General Hospital, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Beatriz Lara Gallego
- University Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Noor A Mahdi
- Lister Hospital, East and North Hertfordshire NHS Trust Stevenage, UK
| | - Caitlin Morgan
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Neena Patel
- Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Elen W Rowlands
- Neville Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, Wales, UK
| | - Matthew S Steward
- Royal Devon & Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Richard S Thorley
- The Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | - Sana Ullah
- Ysbyty Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, Wales, UK
| | - David M Smith
- Integrated Critical Care Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Wojciech Lason
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, UK
| | - Anthony J Rostron
- Integrated Critical Care Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Najib M Rahman
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rob J Hallifax
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Kargirwar KV, Rathod D, Kumar V, Patel M, Shah M, Choudhury H, Shalia K. Clinical Profile of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Developing Pulmonary Barotrauma on Mechanical Ventilation. Indian J Crit Care Med 2022; 26:613-618. [PMID: 35719444 PMCID: PMC9160609 DOI: 10.5005/jp-journals-10071-24149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is limited information on clinical profile and outcomes of patients on mechanical ventilation (MV) who developed pulmonary barotrauma (PBT) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients and methods In a retrospective observational study, all SARS-CoV-2 pneumonia patients admitted from March 28, 2020, to August 31, 2020, at Sir HN Reliance Foundation Hospital and Research Center and Seven Hills Hospital (Reliance Facility), Mumbai, India, of 18 years and above on MV and developed PBT, were included. Results A total of 14 SARS-CoV-2 patients of 45 on MV (31.0%) developed PBT of 1,029 hospitalized. All patients were male and divided as per admission into PaO2/FiO2 (P/F) ≤100 (median 80) and P/F >100 (median 222) group. Pneumothorax developed in seven and six cases of P/F ≤100 and P/F >100 groups, respectively. Three patients in each group developed subcutaneous emphysema, while four developed pneumomediastinum in P/F >100 group. Twelve patients (7, P/F ≤100, and 5, P/F >100) were on invasive, while two (P/F >100) were on noninvasive MV. The mean P/F on the day of PBT was reduced by 27.5 and 65.3%, while peak inspiratory pressure was elevated with a median of 36 and 28 cm H2O in P/F ≤100 and P/F >100 groups, respectively. The median highest tidal volume (420 mL), positive-end expiratory pressure (8 vs 6 cm H2O) on the day of PBT, and length of hospital stay (11 vs 25 days) did not differ between two groups. Survival was 28.6% (4/14). Conclusion SARS-CoV-2 patients requiring MV with PBT had poor outcomes. Clinicians should be vigilant about the diagnosis of PBT. How to cite this article Kargirwar KV, Rathod D, Kumar V, Patel M, Shah M, Choudhury H, et al. Clinical Profile of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Developing Pulmonary Barotrauma on Mechanical Ventilation. Indian J Crit Care Med 2022;26(5):613–618.
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Affiliation(s)
- Ketan V Kargirwar
- Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
- Ketan V Kargirwar, Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India, Phone: +91 8454888103, e-mail:
| | - Darshana Rathod
- Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Mayur Patel
- Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Mehul Shah
- Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Himanshu Choudhury
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Kavita Shalia
- Sir HN Medical Research Society, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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Umbrello M, Venco R, Antonucci E, Cereghini S, Filardo C, Guglielmetti L, Montanari G, Muttini S. Incidence, clinical characteristics and outcome of barotrauma in critically ill patients with COVID-19: a systematic review and meta-analysis. Minerva Anestesiol 2022; 88:706-718. [PMID: 35416463 DOI: 10.23736/s0375-9393.22.16258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Barotrauma is rare in patients with acute respiratory distress syndrome undergoing mechanical ventilation. Its incidence seems increased among critically ill COVID-19 patients. We performed a systematic review and meta-analysis to investigate the incidence, risk factors and clinical outcomes of barotrauma among critically ill COVID-19 patients EVIDENCE ACQUISITION: PubMed was searched from March 1st, 2020 to August 31st, 2021; case series and retrospective cohort studies concerning barotrauma in adult critically ill COVID-19 patients, either hospitalized in the Intensive Care Unit (ICU) or invasively ventilated were included. Primary outcome was the incidence of barotrauma in COVID-19 versus non-COVID-19 patients. Secondary outcomes were clinical characteristics, ventilator parameters, mortality and length of stay between patients with and without barotrauma. EVIDENCE SYNTHESIS We identified 21 studies (six case series, 15 retrospective cohorts). The overall incidence of barotrauma was 11 [95% CI: 8-14]% in critically ill COVID-19 patients, vs. 2 [1-3]% in non-COVID-19, P<0.001; the incidence in mechanically ventilated patients was 14 [11-17]% vs. 4 [2-5]% non-COVID-19 patients, P<0.001. There were no differences in demographic, clinical, ventilatory parameters between patients who did and did not develop barotrauma, while, on average, protective ventilation criteria were always respected. Among COVID-19 patients, those with barotrauma had a higher mortality (60 [55-66] vs. 48 [42-54]%, P<0.001) and a longer ICU length of stay (20 [14-26] vs. 13 [10,5-16] days, P=0.03). CONCLUSIONS Barotrauma is a frequent complication in critically ill COVID-19 patients and is associated with a poor prognosis. Since lung protective ventilation was delivered, the ventilatory management might not be the sole factor in the development of barotrauma.
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Affiliation(s)
- Michele Umbrello
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy -
| | - Roberto Venco
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Edoardo Antonucci
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Sergio Cereghini
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Clelia Filardo
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Luigi Guglielmetti
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Montanari
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Muttini
- Unit of Anesthesia and Resuscitation II, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
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Tonelli R, Bruzzi G, Manicardi L, Tabbì L, Fantini R, Castaniere I, Andrisani D, Gozzi F, Pellegrino MR, Trentacosti F, Dall’Ara L, Busani S, Franceschini E, Baroncini S, Manco G, Meschiari M, Mussini C, Girardis M, Beghè B, Marchioni A, Clini E. Risk Factors for Pulmonary Air Leak and Clinical Prognosis in Patients With COVID-19 Related Acute Respiratory Failure: A Retrospective Matched Control Study. Front Med (Lausanne) 2022; 9:848639. [PMID: 35433732 PMCID: PMC9008271 DOI: 10.3389/fmed.2022.848639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of excessive inspiratory effort in promoting alveolar and pleural rupture resulting in air leak (AL) in patients with SARS-CoV-2 induced acute respiratory failure (ARF) while on spontaneous breathing is undetermined. Methods Among all patients with COVID-19 related ARF admitted to a respiratory intensive care unit (RICU) and receiving non-invasive respiratory support, those developing an AL were and matched 1:1 [by means of PaO2/FiO2 ratio, age, body mass index-BMI and subsequent organ failure assessment (SOFA)] with a comparable population who did not (NAL group). Esophageal pressure (ΔPes) and dynamic transpulmonary pressure (ΔPL) swings were compared between groups. Risk factors affecting AL onset were evaluated. The composite outcome of ventilator-free-days (VFD) at day 28 (including ETI, mortality, tracheostomy) was compared between groups. Results Air leak and NAL groups (n = 28) showed similar ΔPes, whereas AL had higher ΔPL (20 [16–21] and 17 [11–20], p = 0.01, respectively). Higher ΔPL (OR = 1.5 95%CI[1–1.8], p = 0.01), positive end-expiratory pressure (OR = 2.4 95%CI[1.2–5.9], p = 0.04) and pressure support (OR = 1.8 95%CI[1.1–3.5], p = 0.03), D-dimer on admission (OR = 2.1 95%CI[1.3–9.8], p = 0.03), and features suggestive of consolidation on computed tomography scan (OR = 3.8 95%CI[1.1–15], p = 0.04) were all significantly associated with AL. A lower VFD score resulted in a higher risk (HR = 3.7 95%CI [1.2–11.3], p = 0.01) in the AL group compared with NAL. RICU stay and 90-day mortality were also higher in the AL group compared with NAL. Conclusion In spontaneously breathing patients with COVID-19 related ARF, higher levels of ΔPL, blood D-dimer, NIV delivery pressures and a consolidative lung pattern were associated with AL onset.
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Affiliation(s)
- Roberto Tonelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Linda Manicardi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Dario Andrisani
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Gozzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Rosaria Pellegrino
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Fabiana Trentacosti
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Lorenzo Dall’Ara
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Stefano Busani
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | | | - Serena Baroncini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Gianrocco Manco
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Cristina Mussini
- Infectious Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Massimo Girardis
- Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Bianca Beghè
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
- *Correspondence: Alessandro Marchioni,
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy
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Belletti A, Todaro G, Valsecchi G, Losiggio R, Palumbo D, Landoni G, Zangrillo A. Barotrauma in Coronavirus Disease 2019 Patients Undergoing Invasive Mechanical Ventilation: A Systematic Literature Review. Crit Care Med 2022; 50:491-500. [PMID: 34637421 PMCID: PMC8855757 DOI: 10.1097/ccm.0000000000005283] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There are concerns of a high barotrauma rate in coronavirus disease 2019 patients with acute respiratory distress syndrome receiving invasive mechanical ventilation. However, a few studies were published, and reported rates were highly variable. We performed a systematic literature review to identify rates of barotrauma, pneumothorax, and pneumomediastinum in coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation. DATA SOURCE PubMed and Scopus were searched for studies reporting barotrauma event rate in adult coronavirus disease 2019 patients receiving invasive mechanical ventilation. STUDY SELECTION We included all studies investigating adult patients with coronavirus disease 2019 acute respiratory distress syndrome requiring mechanical ventilation. Case reports, studies performed outside ICU setting, and pediatric studies were excluded. Two investigators independently screened and selected studies for inclusion. DATA EXTRACTION Two investigators abstracted data on study characteristics, rate of pneumothorax, pneumomediastinum and overall barotrauma events, and mortality. When available, data from noncoronavirus disease 2019 acute respiratory distress syndrome patients were also collected. Pooled estimates for barotrauma, pneumothorax, and pneumomediastinum were calculated. DATA SYNTHESIS A total of 13 studies with 1,814 invasively ventilated coronavirus disease 2019 patients and 493 noncoronavirus disease 2019 patients were included. A total of 266/1,814 patients (14.7%) had at least one barotrauma event (pooled estimates, 16.1% [95% CI, 11.8-20.4%]). Pneumothorax occurred in 132/1,435 patients (pooled estimates, 10.7%; 95% CI, 6.7-14.7%), whereas pneumomediastinum occurred in 162/1,432 patients (pooled estimates, 11.2%; 95% CI, 8.0-14.3%). Mortality in coronavirus disease 2019 patients who developed barotrauma was 111/198 patients (pooled estimates, 61.6%; 95% CI, 50.2-73.0%). In noncoronavirus disease 2019 acute respiratory distress syndrome patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, -2.1% to 13.5%). CONCLUSIONS Barotrauma occurs in one out of six coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation and is associated with a mortality rate of about 60%. Barotrauma rate may be higher than noncoronavirus disease 2019 controls.
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Affiliation(s)
- Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Todaro
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Valsecchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosario Losiggio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Maiello L, Ball L, Micali M, Iannuzzi F, Scherf N, Hoffmann RT, Gama de Abreu M, Pelosi P, Huhle R. Automatic Lung Segmentation and Quantification of Aeration in Computed Tomography of the Chest Using 3D Transfer Learning. Front Physiol 2022; 12:725865. [PMID: 35185592 PMCID: PMC8854801 DOI: 10.3389/fphys.2021.725865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Identification of lung parenchyma on computer tomographic (CT) scans in the research setting is done semi-automatically and requires cumbersome manual correction. This is especially true in pathological conditions, hindering the clinical application of aeration compartment (AC) analysis. Deep learning based algorithms have lately been shown to be reliable and time-efficient in segmenting pathologic lungs. In this contribution, we thus propose a novel 3D transfer learning based approach to quantify lung volumes, aeration compartments and lung recruitability. METHODS Two convolutional neural networks developed for biomedical image segmentation (uNet), with different resolutions and fields of view, were implemented using Matlab. Training and evaluation was done on 180 scans of 18 pigs in experimental ARDS (u2Net Pig ) and on a clinical data set of 150 scans from 58 ICU patients with lung conditions varying from healthy, to COPD, to ARDS and COVID-19 (u2Net Human ). One manual segmentations (MS) was available for each scan, being a consensus by two experts. Transfer learning was then applied to train u2Net Pig on the clinical data set generating u2Net Transfer . General segmentation quality was quantified using the Jaccard index (JI) and the Boundary Function score (BF). The slope between JI or BF and relative volume of non-aerated compartment (S JI and S BF , respectively) was calculated over data sets to assess robustness toward non-aerated lung regions. Additionally, the relative volume of ACs and lung volumes (LV) were compared between automatic and MS. RESULTS On the experimental data set, u2Net Pig resulted in JI = 0.892 [0.88 : 091] (median [inter-quartile range]), BF = 0.995 [0.98 : 1.0] and slopes S JI = -0.2 {95% conf. int. -0.23 : -0.16} and S BF = -0.1 {-0.5 : -0.06}. u2Net Human showed similar performance compared to u2Net Pig in JI, BF but with reduced robustness S JI = -0.29 {-0.36 : -0.22} and S BF = -0.43 {-0.54 : -0.31}. Transfer learning improved overall JI = 0.92 [0.88 : 0.94], P < 0.001, but reduced robustness S JI = -0.46 {-0.52 : -0.40}, and affected neither BF = 0.96 [0.91 : 0.98] nor S BF = -0.48 {-0.59 : -0.36}. u2Net Transfer improved JI compared to u2Net Human in segmenting healthy (P = 0.008), ARDS (P < 0.001) and COPD (P = 0.004) patients but not in COVID-19 patients (P = 0.298). ACs and LV determined using u2Net Transfer segmentations exhibited < 5% volume difference compared to MS. CONCLUSION Compared to manual segmentations, automatic uNet based 3D lung segmentation provides acceptable quality for both clinical and scientific purposes in the quantification of lung volumes, aeration compartments, and recruitability.
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Affiliation(s)
- Lorenzo Maiello
- Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Marco Micali
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Francesca Iannuzzi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Nico Scherf
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ralf-Thorsten Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Dresden, Technische Universität Dresden, Dresden, Germany
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - Robert Huhle
- Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Savioli G, Alfano C, Zanza C, Bavestrello Piccini G, Varesi A, Esposito C, Ricevuti G, Ceresa IF. Dysbarism: An Overview of an Unusual Medical Emergency. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:104. [PMID: 35056412 PMCID: PMC8778177 DOI: 10.3390/medicina58010104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/03/2023]
Abstract
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
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Affiliation(s)
- Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Claudia Alfano
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Christian Zanza
- “Ospedale Alba-Bra Onlus”—Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | | | - Angelica Varesi
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy;
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Giovanni Ricevuti
- School of Pharmacy, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy;
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Cagle LA, Hopper K, Epstein SE. Complications associated with long-term positive-pressure ventilation in dogs and cats: 67 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:376-385. [PMID: 35001482 DOI: 10.1111/vec.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats. DESIGN Retrospective study from October 2009 to September 2013. SETTING University Teaching Hospital. ANIMALS Fifty-eight dogs and 9 cats. MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed; signalment, complications associated with PPV, duration of PPV, and outcome were recorded. Complications most commonly recorded during PPV included hypothermia 41/67 (61%), hypotension 39/67 (58%), cardiac arrhythmias 33/67 (49%), a positive fluid balance 31/67 (46%), oral lesions 25/67 (37%), and corneal ulcerations 24/67 (36%). A definition of ventilator-associated events (VAE) extrapolated from the Center of Disease Control's criteria was applied to 21 cases that received PPV for at least 4 days in this study. Ventilator-associated conditions occurred in 5 of 21 (24%) of cases with infection-related ventilator-associated conditions and ventilator-associated pneumonia identified in 3 of 21 (14%) cases. CONCLUSIONS Complications are common and diverse in dogs and cats receiving long-term PPV and emphasizes the importance of intensive, continuous patient monitoring and appropriate nursing care protocols. Many of the complications identified could be serious without intervention and suggests that appropriate equipment alarms could improve patient safety. Development of veterinary specific surveillance tools such as the VAE criteria would aid future investigations and allow for effective multicenter studies.
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Affiliation(s)
- Laura A Cagle
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
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Soler-Silva Á, Sánchez-Guillén L, Rodriguez-Arias FL, Arroyo A. Negative pressure therapy as a safe alternative in the treatment of massive subcutaneous emphysema in critically ill patients COVID-19. Heart Lung 2022; 52:190-193. [PMID: 35063307 PMCID: PMC8755478 DOI: 10.1016/j.hrtlng.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 01/25/2023]
Abstract
Many surgical treatments have been described for massive subcutaneous emphysema (MSE) over the recent years. However, there is no consensus on which is the most recommended and there is great diversity in treatment. With new advances in minimally invasive therapy performed at the bedside, especially in intensive care units, it has been possible to increase therapeutic efficacy. During the COVID-19 pandemic, some therapeutic techniques have been discussed in critically ill patients with SARS-COV-2 respiratory infections, because of the potential overexposure of healthcare personnel to an increased risk of contagion after direct exposure to air trapped in the subcutaneous tissue of infected patients. We present the clinical case of an 82-year-old male patient, SARS COV-2 infected, with MSE after 48 h with invasive mechanical ventilation in critical intensive care. He was treated with negative pressure therapy (NPT) allowing effective resolution of the MSE in a short period (5 days) with a minimally invasive bedside approach, reducing the potential air exposure of health personnel by keeping the viral load retained by the emphysema. Therefore, we present NPT as an effective, minimally invasive and safe therapeutic alternative to be considered in the management of MSE in critically ill patients infected with SARS COV-2.
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Affiliation(s)
- Álvaro Soler-Silva
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain,Corresponding author at: Camino de la Almazara 11, Hospital General Universitario de Elche, 03203 Elche. Alicante, Spain
| | - Francisco López Rodriguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
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Korula P, Sharma P, Mohanty R, Kurian P, Vincent D, Dadsena A, Mane M, Narayanan S, Babu S. Air leak syndromes (Pneumomediastinum, pneumothorax, and subcutaneous emphysema) in critically ill COVID-19 patients – Prevalence, risk factors, and outcome. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_82_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Manasrah N, Abdelazeem B, Al Qasem S, Kandah E, Chaudhary AJ. Extracorporeal Membrane Oxygenation (ECMO): A Life Saver in Near-Fatal Asthma. Cureus 2021; 13:e20117. [PMID: 34984154 PMCID: PMC8720297 DOI: 10.7759/cureus.20117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
Near-fatal asthma (NFA) is a life-threatening condition that represents the most severe clinical phenotype of asthma and can progress to fatal asthma. Patients with NFA do not respond adequately to conventional medical therapy and urgent intervention is needed to provide adequate oxygenation by invasive mechanical ventilation. While mechanical ventilation is a potentially life-saving intervention, it could cause lung injury, barotrauma, and dynamic hyperinflation due to high ventilator settings resulting in hemodynamic instability. Extracorporeal membrane oxygenation (ECMO) provides full respiratory support with adequate gas exchange in patients with NFA and improves survival rate. We present a case of a young female patient who presented with NFA, and her clinical condition was worsening despite invasive positive pressure mechanical ventilation.
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