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Chandna S, Raj K, Agrawal A, Nanda S, Jyotheeswara Pillai K, Bhagat U, Bajaj S, Raoof S, Mehta AC. Prevalence and patient risk factors for pneumothorax in COVID-19 and in influenza pneumonia: a nationwide comparative analysis. J Thorac Dis 2024; 16:3593-3605. [PMID: 38983184 PMCID: PMC11228741 DOI: 10.21037/jtd-23-1454] [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: 09/16/2023] [Accepted: 03/15/2024] [Indexed: 07/11/2024]
Abstract
Background Pneumothorax is a rare but deadly complication in patients who require mechanical ventilation. As with any condition associated with acute respiratory distress syndrome (ARDS), coronavirus disease 2019 (COVID-19) is known to be associated with pneumothorax. However, in the literature, comparative data on the risk factors for pneumothorax in COVID-19 and other diseases like influenza are limited. The aim of this study is to determine the prevalence and risk factors for pneumothorax in hospitalized COVID-19 patients and compare them with influenza pneumonia patients. Methods This study is a retrospective analysis of the National Inpatient Sample (NIS) 2020 database cohort. Univariate and multivariate logistic regression were used to identify the prevalence and risk factors for pneumothorax in COVID-19 patients and compared with the risk of pneumothorax in influenza patients. Results The NIS 2020 database includes 1,608,980 hospitalizations of COVID-19 patients, of which 22,545 [95% confidence interval (CI): 21,491-23,598] (1.4%) developed pneumothorax. On multivariate analysis, factors associated with pneumothorax in COVID-19 included patient age of 41-64 years; male sex; Hispanics, Native Americans, and other races; hospitals with large-bed size; privately owned hospitals; urban teaching hospitals; hospitals in the southern United States (US); stroke; malnutrition; chronic obstructive pulmonary disease (COPD); bronchiectasis; pulmonary fibrosis; liver disease; non-invasive and invasive ventilation; and extracorporeal membrane oxygenation (ECMO). Of 184,980 influenza patients, 1,630 (95% CI: 1,448-1,811) (0.88%) developed pneumothorax. The prevalence of pneumothorax was higher (1.4%) in COVID-19 patients compared to patients with influenza pneumonia (0.88%). Conclusions COVID-19 patients who develop pneumothorax have a poor prognosis. Several risk factors for the development of pneumothorax were identified. Patients with these risk factors should be prioritized in applying evidence-based guidelines to prevent pneumothorax.
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Affiliation(s)
- Sanya Chandna
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kavin Raj
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Ankit Agrawal
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Saumya Nanda
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Umesh Bhagat
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Suhail Raoof
- Lung Institute, Northwell Health, New York, NY, USA
| | - Atul C. Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Carrero-Cardenal E, Vollmer-Torrubiano I, Torres-López M, Martín-Barrera G, Casanovas-Mateu G, Tercero-Machin FJ, Paez-Carpio A, Fábregas-Julià N, Valero-Castell R. Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial. Insights Imaging 2024; 15:153. [PMID: 38900225 PMCID: PMC11190131 DOI: 10.1186/s13244-024-01721-9] [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: 02/14/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.
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Affiliation(s)
- Enrique Carrero-Cardenal
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Ivan Vollmer-Torrubiano
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marta Torres-López
- Centre for Biomedical Research in the Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Martín-Barrera
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Surgical Area Nursing Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Alfredo Paez-Carpio
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Neus Fábregas-Julià
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Clinical Quality and Safety Directorate, Surgical Area, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Valero-Castell
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Sawanyawisuth K, Jamil SM, Lipford MC. Editorial: Clinical aspects of obstructive sleep apnea and cardiovascular consequences. Front Neurol 2022; 13:961240. [PMID: 36277923 PMCID: PMC9583658 DOI: 10.3389/fneur.2022.961240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- *Correspondence: Kittisak Sawanyawisuth
| | - Shazia M. Jamil
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Scripps Clinic, La Jolla, CA, United States
| | - Melissa C. Lipford
- Department of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
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Guy EFS, Knopp JL, Gilbertson O, Blue S, Holder-Pearson L, Chase JG. CPAP pressure and flow data at 2 positive pressure levels and multiple controlled breathing rates from a trial of 30 adults. BMC Res Notes 2022; 15:257. [PMID: 35842701 PMCID: PMC9288698 DOI: 10.1186/s13104-022-06133-w] [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: 03/16/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES A unique dataset of airway flow/pressure from healthy subjects on Continuous Positive Airway Pressure (CPAP) ventilation was collected. This data can be used to develop or validate models of pulmonary mechanics, and/or to develop methods to identify patient-specific parameters which cannot be measured non-invasively, during CPAP therapy. These models and values, particularly if available breath-to-breath in real-time, could assist clinicians in the prescription or optimisation of CPAP therapy, including optimising PEEP settings. DATA DESCRIPTION Data was obtained from 30 subjects for model-based identification of patient-specific lung mechanics using a specially designed venturi sensor system comprising an array of differential and gauge pressure sensors. Relevant medical information was collected using a questionnaire, including: sex; age; weight; height; smoking history; and history of asthma. Subjects were tasked with breathing at five different rates (including passive), matched to an online pacing sound and video, at two different levels of PEEP (4 and 7 cmH2O) for between 50 and 180 s. Each data set comprises ~ 17 breaths of data, including rest periods between breathing rates and CPAP levels.
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Affiliation(s)
- Ella F S Guy
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand.
| | - Jennifer L Knopp
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Oliver Gilbertson
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Simon Blue
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Lui Holder-Pearson
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - J Geoffrey Chase
- Department of Mechanical Engineering, Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
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Chohan K, Mittal N, McGillis L, Lopez-Hernandez L, Camacho E, Rachinsky M, Mina DS, Reid WD, Ryan CM, Champagne KA, Orchanian-Cheff A, Clarke H, Rozenberg D. A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders. Chron Respir Dis 2021; 18:14799731211025313. [PMID: 34291699 PMCID: PMC8312172 DOI: 10.1177/14799731211025313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ehlers-Danlos Syndromes (EDS) and Hypermobility Spectrum Disorders (HSD) are a heterogeneous group of heritable genetic connective tissue disorders with multiple characteristics including joint hypermobility, tissue fragility, and multiple organ dysfunction. Respiratory manifestations have been described in EDS patients, but have not been systematically characterized. A narrative review was undertaken to describe the respiratory presentations and management strategies of individuals with EDS and HSD. METHODS A broad literature search of Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL was undertaken from inception to November 2020 of all study types, evaluating EDS/ HSD and pulmonary conditions. This narrative review was limited to adult patients and publications in English. RESULTS Respiratory manifestations have generally been described in hypermobile EDS (hEDS), classical and vascular EDS subtypes. Depending on EDS subtype, they may include but are not limited to dyspnea, dysphonia, asthma, sleep apnea, and reduced respiratory muscle function, with hemothorax and pneumothorax often observed with vascular EDS. Respiratory manifestations in HSD have been less frequently characterized in the literature, but exertional dyspnea is the more common symptom described. Respiratory symptoms in EDS can have an adverse impact on quality of life. The respiratory management of EDS patients has followed standard approaches with thoracotomy tubes and pleurodesis for pleural manifestations, vocal cord strengthening exercises, continuous positive pressure support for sleep apnea, and exercise training. Reduced respiratory muscle function in hEDS patients responds to inspiratory muscle training. CONCLUSION Respiratory symptoms and manifestations are described in EDS and HSD, and have generally been managed using conservative non-surgical strategies. Research into the prevalence, incidence and specific respiratory management strategies in EDS and HSD is needed to mitigate some of the associated morbidity.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nimish Mittal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - Laura McGillis
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura Lopez-Hernandez
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Encarna Camacho
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Maxim Rachinsky
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - W Darlene Reid
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh Mai Ryan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Hance Clarke
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
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