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Bonaffini PA, Stanco F, Dulcetta L, Poli G, Brambilla P, Marra P, Valle C, Lorini FL, Mazzoleni M, Sonzogni B, Previdi F, Sironi S. Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak. Tomography 2023; 9:2211-2221. [PMID: 38133075 PMCID: PMC10748272 DOI: 10.3390/tomography9060171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.
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Affiliation(s)
- Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Francesco Stanco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Giancarla Poli
- Unit of Intensive Care and Anesthesia 2, Papa Giovanni XXIII Hospital, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Paolo Brambilla
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Ferdinando Luca Lorini
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Unit of Intensive Care and Anesthesia 2, Papa Giovanni XXIII Hospital, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Mirko Mazzoleni
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Beatrice Sonzogni
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Fabio Previdi
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
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Bajto P, Saric I, Bugarin JD, Delic N, Dosenovic S, Ilic D, Stipic SS, Duplancic B, Saric L. Barotrauma in patients with severe coronavirus disease 2019-retrospective observational study. J Thorac Dis 2023; 15:5297-5306. [PMID: 37969263 PMCID: PMC10636462 DOI: 10.21037/jtd-23-677] [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: 04/23/2023] [Accepted: 08/18/2023] [Indexed: 11/17/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although it is known that the COVID-19 acute respiratory distress syndrome (ARDS) is associated with higher incidence of pulmonary barotrauma, unique mechanisms causing the aforementioned complication are still to be investigated. The goal of this research was to investigate the incidence of barotrauma among COVID-19 patients treated in the intensive care unit (ICU) and to examine different clinical outcomes among those subjects. Methods This retrospective observational cohort study included adult COVID-19 patients admitted to ICU from September 1, 2020, to February 28, 2022. All admitted subjects received invasive respiratory support. Subjects were divided into two groups based on occurrence of pulmonary barotrauma. Data were collected from available electronical medical records. Results In the study period, a total of 900 subjects met inclusion criteria. Pulmonary barotrauma occurred in 88 (9.8%) of them. Subcutaneous emphysema developed in 73 (83%), pneumomediastinum in 68 (77.3%) and pneumothorax in 54 (61.4%) subjects. A small group of subjects developed less common complications like pneumoperitoneum (8 subjects, 9.1%) and pneumopericardium (2 subjects, 2.3%). Survival rate was higher in control than in barotrauma group [396 (48.8%) vs. 22 (25.0%), P<0.05]. There was also a significant difference between two groups in PaO2/FiO2 ratio on admission, duration of non-invasive respiratory support before mechanical ventilation, duration of mechanical ventilation and duration of ICU and hospital stay, all in favour of control group. Conclusions Development of barotrauma in patients with severe forms of COVID-19 disease and in need of respiratory support is associated with longer ICU and hospital stay as well as lower survival rates at hospital discharge. Further efforts are needed in understanding mechanism in developing barotrauma and finding new prevention and treatment options.
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Affiliation(s)
- Petra Bajto
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Ivana Saric
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Josipa Domazet Bugarin
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Nikola Delic
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Svjetlana Dosenovic
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Darko Ilic
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Sanda Stojanovic Stipic
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Bozidar Duplancic
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
| | - Lenko Saric
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
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Baslas R, Condurache DG, Jayal A, Colquhoun M, de Wolff JF. Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study. Postgrad Med J 2023; 99:570-575. [PMID: 37319146 PMCID: PMC9044514 DOI: 10.1136/postgradmedj-2022-141642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Various complications have been reported in patients with COVID-19 including pneumomediastinum. METHODS The primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum. We undertook an observational, retrospective, single-centre, cohort study of patients with COVID-19 admitted to Northwick Park Hospital. RESULTS 74 patients in the first wave and 220 patients in the second wave met the study criteria. Two patients during the first wave and eleven patients during the second wave developed pneumomediastinum. CONCLUSIONS The incidence of pneumomediastinum changed from 2.7% during the first wave to 5% during the second wave and this change was not statistically significant (p value 0.4057). The difference in mortality rates of patients with pneumomediastinum in both waves of COVID-19 (69.23%) versus patients without pneumomediastinum in both waves of COVID-19 (25.62%) was statistically significant (p value 0.0005). Many patients with pneumomediastinum were ventilated, which could be a confounding factor. When controlling for ventilation, there was no statistically significant difference in the mortality rates of ventilated patients with pneumomediastinum (81.81%) versus ventilated patients without pneumomediastinum (59.30%) (p value 0.14).
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Affiliation(s)
- Rohit Baslas
- Acute Medicine, London North West Healthcare NHS Trust, Harrow, UK
| | | | - Ambikesh Jayal
- Data Science, School of Information Systems and Technology, University of Canberra, Canberra, Australian Capital Territory, Australia
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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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Abstract
OBJECTIVES Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia. DESIGN Retrospective observational study. SETTING Population-based, single-setting, tertiary-care level COVID treatment center. PATIENTS Individuals hospitalized with a diagnosis of COVID-19 pneumonia and severe to critical illness were included. Those hospitalized without respiratory failure, observed for less than 24 hours, or admitted from an ICU were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All patients underwent a complete clinical assessment and chest CT scan, and were followed up from hospitalization to discharge or death. The outcome was the number of cases of PNM, defined as the presence of free air in the mediastinal tissues diagnosed by chest CT scan, in non-ICU hospitalized patients and the subsequent risk of intubation and mortality. PNM occurred in 48 out of 331 participants. The incidence was 14.5% (95% CI, 10.9-18.8%). A CT-Scan Severity score greater than 15 was positively associated with PNM (odds ratio [OR], 4.09; p = 0.002) and was observed in 35.2% of the participants (95% CI, 26.2-44.9%). Noninvasive ventilation was also positively associated with PNM (OR, 4.46; p = 0.005), but there was no positive association with airway pressures. Fifty patients (15%) were intubated, and 88 (27%) died. Both the risk for intubation and mortality were higher in patients with PNM, with a hazard ratio of 3.72 ( p < 0.001) and 3.27 ( p < 0.001), respectively. CONCLUSIONS Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.
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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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Patel N, Nicolae R, Geropoulos G, Mandal P, Christou CD, Gavala M, Madouros N, Papapanou M, Mogal R, Giannis D, Kechagias KS, Panagiotopoulos N. Pneumomediastinum in the COVID-19 era: to drain or not to drain? Monaldi Arch Chest Dis 2022; 93. [PMID: 35904103 DOI: 10.4081/monaldi.2022.2338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023] Open
Abstract
Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.
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Affiliation(s)
- Nian Patel
- Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London.
| | - Robert Nicolae
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Georgios Geropoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London.
| | - Pallabhi Mandal
- Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London.
| | | | | | | | | | - Rahul Mogal
- Respiratory Medicine Department, Watford General Hospital, West Hertfordshire Hospitals, NHS Foundation Trust, Hertfordshire.
| | | | - Konstantinos S Kechagias
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London.
| | - Nikolaos Panagiotopoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK..
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Dubey R, Sen KK, Mishra A. Barotrauma and its complications in COVID-19 patients: a retrospective study at tertiary care hospital of Eastern India. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:212. [PMID: 35854795 PMCID: PMC9284477 DOI: 10.1186/s42269-022-00880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The development of barotrauma in COVID-19 patients who were ventilated and admitted to the intensive treatment unit seemed to have been a problematic issue in the COVID era. This study aimed to explore the possibility of developing the barotrauma-related issues with mechanical ventilation in the cases of individuals suffering from COVID-19. RESULTS Out of 48 patients who developed barotrauma, 30 (62.5%) presented with pneumothorax, 22 (45.8%) with pneumomediastinum, 10 (20.8%) with subcutaneous emphysema, and 2 (4.1%) with pneumopericardium. Of those that developed barotrauma, 45 (93.7%) patients were in acute respiratory distress syndrome. In patients with and without barotrauma, significant factors were white blood cell count (p = 0.001), neutrophil percentage (p = 0.012), and lymphocyte percentage (p = 0.014). There were no statistically significant differences in CRP, procalcitonin, d-dimer test, LDH, or ferritin. CONCLUSIONS Patients infected with COVID-19 have a high risk of barotrauma when on mechanical ventilation. As a result, the death rate in this patient group is higher.
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Affiliation(s)
- Roopak Dubey
- Department of Radiodiagnosis, Kalinga Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha India
| | - Kamal Kumar Sen
- Department of Radiodiagnosis, Kalinga Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha India
| | - Aparajita Mishra
- Department of Community Medicine, Kalinga Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha India
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Kajenthiran R, Tiwary MK, Lal A, Paul J, Al Sawafi F, Manhas Y, Yadav A, Al Harthi Z, Nair A. Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman. Cureus 2022; 14:e26414. [PMID: 35911291 PMCID: PMC9335402 DOI: 10.7759/cureus.26414] [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] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background During the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients developed pulmonary barotrauma either self-inflicted or ventilator-induced. In pulmonary barotrauma, air leaks into extra-alveolar tissue resulting in pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum. Methods After obtaining institutional approval, we retrospectively reviewed data from March 1, 2021, to September 31, 2021. Being a retrospective study, informed consent was not applicable. Patient data were collected from the Al Shifa patient information portal, which is an electronic medical record system available to all hospitals in the Ministry of Health, Oman. After identifying patients with pulmonary barotrauma, the following details were recorded and entered into an Excel sheet (Microsoft Corporation, Albuquerque, New Mexico) and a database was created, which contained the following: age, sex, smoking history, comorbidities, type, location, mode of barotrauma, mode of ventilation, length of intensive care unit (ICU) stay, interventions performed, and overall outcome (survived/deceased). Results A total of 529 patients with COVID-19 pneumonia were admitted from March 2021 to September 2021 to the ICU. Twenty-eight patients developed barotrauma of variable severity and required interventions like the placement of intercostal drains. Out of 28, five patients developed spontaneous barotrauma, 14 patients had barotrauma after initiation of non-invasive ventilation, and nine patients had barotrauma as a result of invasive ventilation. The median number of days in the ICU was 19.5 (interquartile range: 12.5-26.5). Of the 28 patients, eight patients survived and were discharged from the hospital. Conclusion In this single-center, retrospective study at a secondary care hospital in Oman, we described our experience with patients who suffered pulmonary barotrauma during their ICU admission. We have also presented the incidence of spontaneous versus ventilator-induced barotrauma, the length of stay of these patients, the outcomes in terms of survival or death, the need for tracheostomy, secondary infections, and interventions performed as indicated.
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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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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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12
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Özdemir S, Bilgi DÖ, Hergünsel GO, Çitak N. Incidence and risk factors for pneumomediastinum in COVID-19 patients in the intensive care unit. Interact Cardiovasc Thorac Surg 2021; 34:236-244. [PMID: 34597367 PMCID: PMC8766215 DOI: 10.1093/icvts/ivab258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/21/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The incidence of pneumomediastinum (PNMD), its causes of development and its effect on prognosis in the coronavirus disease 2019 (COVID-19) are not clear. METHODS Between March 2020 and December 2020, 427 patients with real-time reverse transcriptase-polymerase chain reaction-confirmed COVID-19 admitted to the intensive care unit were analysed retrospectively. Using receiver operating characteristic analysis, the area under the curve (AUC) for initial invasive mechanical ventilation (MV) variables such as initial peak inspiratory pressure (PIP), PaO2/FiO2 (P/F ratio), tidal volume, compliance and positive end-expiratory pressure was evaluated regarding PNMD development. RESULTS The incidence of PNMD was 5.6% (n = 24). PNMD development rate was 2.7% in non-invasive MV and 6.2% in MV [odds ratio (OR) 2.352, 95% confidence interval (CI) 0.541–10.232; P = 0.400]. In the multivariate analysis, the independent risk factors affecting the development of PNMD were PIP (OR 1.238, 95% CI 1.091–1.378; P < 0.001) and P/F ratio (OR 0.982, 95% CI 0.971–0.994; P = 0.004). P/F ratio (AUC 0.815, 95% CI 0.771–0.854), PIP (AUC 0.780, 95% CI 0.734–0.822), compliance (AUC 0.735, 95% CI 0.677–0.774) and positive end-expiratory pressure (AUC 0.718, 95% CI 0.668–0.764) were the best predictors for PNMD development. Regarding the multivariate analysis, independent risk factors affecting mortality were detected as age (OR 1.015, 95% CI 0.999–1.031; P = 0.04), comorbidity (OR 1.940, 95% CI 1.100–3.419; P = 0.02), mode of breathing (OR 48.345, 95% CI 14.666–159.360; P < 0.001), PNMD (OR 5.234, 95% CI 1.379–19.857; P = 0.01), positive end-expiratory pressure (OR 1.305, 95% CI 1.062–1.603; P = 0.01) and tidal volume (OR 0.995, 95% CI 0.992–0.998; P = 0.004). CONCLUSIONS PNMD development was associated with the initial P/F ratio and PIP. Therefore, it was considered to be related to both the patient and barotrauma. PNMD is a poor prognostic factor for COVID-19.
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Affiliation(s)
- Servet Özdemir
- Thoracic Surgery Department, Bakırköy Dr. Sadi Konuk Research and Education Hospital, İstanbul, Turkey
| | - Deniz Özel Bilgi
- Anesthesiology and Reanimation Department, Bakırköy Dr. Sadi Konuk Research and Education Hospital, İstanbul, Turkey
| | - Gülsüm Oya Hergünsel
- Anesthesiology and Reanimation Department, Bakırköy Dr. Sadi Konuk Research and Education Hospital, İstanbul, Turkey
| | - Necati Çitak
- Thoracic Surgery Department, Bakırköy Dr. Sadi Konuk Research and Education Hospital, İstanbul, Turkey
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13
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Belletti A, Landoni G, Zangrillo A. Pneumothorax and barotrauma in invasively ventilated patients with COVID-19. Respir Med 2021; 187:106552. [PMID: 34364198 PMCID: PMC8323514 DOI: 10.1016/j.rmed.2021.106552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- 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
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14
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Gazivoda VP, Ibrahim M, Kangas-Dick A, Sun A, Silver M, Wiesel O. Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia. J Intensive Care Med 2021; 36:1176-1183. [PMID: 34151633 PMCID: PMC8221250 DOI: 10.1177/08850666211023360] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Pneumomediastinum and pneumothorax are complications which may be associated
with barotrauma in mechanically ventilated patients. The current literature
demonstrates unclear outcomes regarding barotrauma in critically ill
patients with severe COVID-19. The purpose of this study was to examine the
incidence of barotrauma in patients with severe COVID-19 pneumonia and its
influence on survival. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5,
2020, with follow-up through June 18, 2020, encompassing critically ill
intubated patients admitted for COVID-19 pneumonia at an academic tertiary
care hospital in Brooklyn, New York. Critically ill patients with
pneumomediastinum, pneumothorax, or both (n = 75) were compared to those
without evidence of barotrauma (n = 206). Clinical characteristics and
short-term patient outcomes were analyzed. Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable
analysis, factors associated with increased 30-day mortality were elevated
age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma
(1.417 [1.040-1.931], P = 0.027), and renal dysfunction
(1.602 [1.055-2.432], P = 0.027). Protective factors were
administration of remdesivir (0.479 [0.321-0.714], P <
0.001) and receipt of steroids (0.488 [0.370-0.643], P <
0.001). Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with
COVID-19 pneumonia and was found to be an independent risk factor for 30-day
mortality.
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Affiliation(s)
- Victor P Gazivoda
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Mudathir Ibrahim
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron Kangas-Dick
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Arony Sun
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Division of Biostatistics, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Ory Wiesel
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA.,Division of Thoracic Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
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15
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Gabrielli M, Valletta F, Franceschi F. Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits. Br J Hosp Med (Lond) 2021; 82:1-9. [PMID: 34191558 DOI: 10.12968/hmed.2021.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.
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Affiliation(s)
- M Gabrielli
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Valletta
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Franceschi
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Rajdev K, Spanel AJ, McMillan S, Lahan S, Boer B, Birge J, Thi M. Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation. J Intensive Care Med 2021; 36:1013-1017. [PMID: 34013825 DOI: 10.1177/08850666211019719] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We experienced a high incidence of pulmonary barotrauma among patients with coronavirus disease-2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) at our institution. In current study, we sought to evaluate the incidence, clinical outcomes, and characteristics of barotrauma among COVID-19 patients receiving invasive and non-invasive positive pressure ventilation. METHODOLOGY This retrospective cohort study included adult patients diagnosed with COVID-19 pneumonia and requiring oxygen support or positive airway pressure for ARDS who presented to our tertiary-care center from March through November, 2020. RESULTS A total of 353 patients met our inclusion criteria, of which 232 patients who required heated high-flow nasal cannula, continuous or bilevel positive airway pressure were assigned to non-invasive group. The remaining 121 patients required invasive mechanical ventilation and were assigned to invasive group. Of the total 353 patients, 32 patients (65.6% males) with a mean age of 63 ± 11 years developed barotrauma in the form of subcutaneous emphysema, pneumothorax, or pneumomediastinum. The incidence of barotrauma was 4.74% (11/232) and 17.35% (21/121) in the non-invasive group and invasive group, respectively. The median length of hospital stay was 22 (15.7 -33.0) days with an overall mortality of 62.5% (n = 20). CONCLUSIONS Patients with COVID-19 ARDS have a high incidence of barotrauma. Pulmonary barotrauma should be considered in patients with COVID-19 pneumonia who exhibit worsening of their respiratory disease as it is likely associated with a high mortality risk. Utilizing lung-protective ventilation strategies may reduce the risk of barotrauma.
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Affiliation(s)
- Kartikeya Rajdev
- Pulmonary, Critical Care & Sleep Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan J Spanel
- Department of Internal Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Sean McMillan
- Department of Internal Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Shubham Lahan
- 79317University College of Medical Sciences, New Delhi, Delhi, India
| | - Brian Boer
- Pulmonary, Critical Care & Sleep Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Justin Birge
- Department of Internal Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Meilinh Thi
- Pulmonary, Critical Care & Sleep Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA
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17
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Ng TG, Degaetano E, Trivedi U, Akthar M. Barotrauma Linked to Coronavirus Disease 2019 Infection in Younger Patients: A Case Series. Cureus 2021; 13:e14573. [PMID: 34026386 PMCID: PMC8135069 DOI: 10.7759/cureus.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patients infected with coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation were found to have high rates of barotrauma. Herein, we present five patients admitted to the intensive care unit between March and April 2020, who developed barotrauma as a complication of COVID-19 pneumonia. This series includes four males and one female with a mean age of 54 years, most without significant chronic comorbidities or former tobacco use. All were intubated for hypoxic respiratory failure due to the COVID-19 infection. The diagnosis of barotrauma was confirmed via radiography showing the presence of pneumothorax, pneumomediastinum, or subcutaneous emphysema on radiographic imaging. At the time, they were evaluated for convalescent plasma infusion, remdesivir, and interleukin-6 inhibitor. Each of the five patient's hospital courses were documented. The average number of days between intubation and subsequent barotrauma was 6.8 days with the mean length of hospital stay being 49 days. Three of the five patients passed away due to complications related to COVID-19. Due to the unknown nature of the virus, our findings add to the growing evidence that those infected, even without significant comorbidities, are at high risk for pulmonary complications and in-hospital mortality.
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Affiliation(s)
- Thomas G Ng
- Internal Medicine, Rutgers University, Newark, USA
| | | | - Usha Trivedi
- Internal Medicine, Rutgers University, Newark, USA
| | - Morium Akthar
- Pulmonary Critical Care Medicine, Rutgers University, Newark, USA
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18
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Bhakta P, Reazaul Karim HM, Mandal M, O'Brien B, Esquinas AM. Barotrauma in covid - Causes and consequences. Ann Med Surg (Lond) 2021; 64:102189. [PMID: 33688428 PMCID: PMC7931731 DOI: 10.1016/j.amsu.2021.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pradipta Bhakta
- Department of Anaesthesiology and Intensive Care, University Hospital Kerry, Tralee, Co, Kerry, Ireland
| | - Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Mohanchandra Mandal
- Department of Anaesthesiology and Intensive Care, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Brian O'Brien
- Department of Anaesthesiology and Intensive Care, Cork University Hospital, Cork, Ireland
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19
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Belletti A, Palumbo D, Zangrillo A, Fominskiy EV, Franchini S, Dell'Acqua A, Marinosci A, Monti G, Vitali G, Colombo S, Guazzarotti G, Lembo R, Maimeri N, Faustini C, Pennella R, Mushtaq J, Landoni G, Scandroglio AM, Dagna L, De Cobelli F. Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients. J Cardiothorac Vasc Anesth 2021; 35:3642-3651. [PMID: 33678544 PMCID: PMC8054543 DOI: 10.1053/j.jvca.2021.02.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
Objective To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design Observational study. Setting Tertiary-care university hospital. Participants One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. Interventions The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. Measurements and Main Results PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). Conclusion PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.
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Affiliation(s)
- Alessandro Belletti
- 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
| | - 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
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Franchini
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Dell'Acqua
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Vitali
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Guazzarotti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Maimeri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carolina Faustini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renato Pennella
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Junaid Mushtaq
- 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.
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, 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
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20
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Hamouri S, Samrah SM, Albawaih O, Saleh Z, Smadi MM, Alhazymeh A, Syaj S. Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation. Int J Gen Med 2021; 14:2017-2032. [PMID: 34079341 PMCID: PMC8164351 DOI: 10.2147/ijgm.s314155] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study aims to determine the incidence and outcome of COVID-19 patients who required positive pressure ventilation (PPV) and subsequently developed pulmonary barotrauma (PBT). Also, to investigate the risk factors and predictors of these complications to better understand the disease pathogenesis. PATIENTS AND METHODS This retrospective analysis enrolled all adult COVID-19 patients admitted through the period from October 1, 2020, to December 31, 2020. All patients who received any form of PPV were included. Patients were then divided into two groups based on PBT development, including subcutaneous emphysema, pneumothorax, and pneumomediastinum. Medical records of all patients were reviewed. Patients' demographics, laboratory data on admission, respiratory support modes, surgical interventions, and outcomes were collected and analyzed. RESULTS In the specified period, 1095 patients were hospitalized due to COVID-19 illness. A total of 239 (21.8%) of all admitted patients received PPV. PBT accounted for 21.3% (51/239) of the study cohort. While both groups were equally exposed to the same modes of PPV, receiving invasive ventilation significantly correlated with decreased PBT odds (OR = 0.891; 95% CI, 0.803-0.988; p=0.029). PBT patients were significantly younger (p<0.001). Diabetes mellitus was found to have a protective effect on developing PBT (OR = 0.867; 95% CI, 0.782-0.962), while PO2/FIO2 ratio was inversely associated with higher odds of developing PBT in both univariate and multivariate analyses (p=0.03 and p=0.019, respectively). CONCLUSION COVID-19-infected patients are at a higher risk of developing PBT. Invasive positive pressure ventilation was associated with less PBT compared to noninvasive ventilation and delaying intubation does not seem to reduce the risk of pulmonary barotrauma.
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
- Correspondence: Shadi Hamouri Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box 3030, Irbid, 22110, JordanTel +962 79 6266693Fax +962-2-7095010 Email
| | - Shaher M Samrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
| | - Omar Albawaih
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
| | - Zidan Saleh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
| | - Mahmoud M Smadi
- Department of Mathematics and Statistics, Faculty of Science and Art, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ahmad Alhazymeh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
| | - Sebawe Syaj
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan
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