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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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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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Sharma N, Chahal A, Sharma A. Chest Physiotherapy Interventions for Children During SARS-COV-2 Pandemic. Clin Pediatr (Phila) 2024; 63:96-107. [PMID: 37098728 PMCID: PMC10133862 DOI: 10.1177/00099228231169892] [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] [Indexed: 04/27/2023]
Abstract
Since the first case of Severe Acute Respiratory Syndrome Coronavirus-2/Coronavirus Disease 2019 (SARS-COV-2/COVID-19) was discovered in Wuhan, China, it spread to vast limits globally and became a public health disaster, affecting nearly all countries around the globe. Along with mainstream medical treatment, alternative medicine desperately was the need of the hour for youngsters to manage their symptoms while being self-quarantined and ultimately to improve their chances of survival and recovery from COVID-19. Since the beginning of SARS-COV-2, few studies address the clinical-functional presentation of viral infection and management with physiotherapy for children. Major online electronic databases PubMed, PEDro, and Google Scholar were researched to identify, organize and commission the current review. To create a search strategy, Medical Subject Headings and Descriptors of Science and Health were utilized. The authors looked for other studies by screening the references list of the potentially pertinent papers. These computerized searches turned up studies and those studies' bibliographies with pertinent citations were examined. Personal protective equipment was a crucial component for protection and contact precaution. Following hypoxia, effective oxygen therapy is administered right away. When necessary, under the right circumstances, nasal high-flow oxygen therapy, non-invasive ventilation, lung-protective breathing methods, and prone positioning can be used. Children with SARS-CoV-2/COVID-19 may benefit from physiotherapy interventions with a focus on ventilatory management, airway clearance procedures, early activities, and mobilization.
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Affiliation(s)
- Nidhi Sharma
- Department of Neurological Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Aksh Chahal
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Greater Noida 20320, Uttar Pradesh, India
| | - Abhishek Sharma
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, India
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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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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: 15] [Impact Index Per Article: 15.0] [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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Stoian M, Roman A, Boeriu A, Onișor D, Bandila SR, Babă DF, Cocuz I, Niculescu R, Costan A, Laszlo SȘ, Corău D, Stoian A. Long-Term Radiological Pulmonary Changes in Mechanically Ventilated Patients with Respiratory Failure due to SARS-CoV-2 Infection. Biomedicines 2023; 11:2637. [PMID: 37893011 PMCID: PMC10604756 DOI: 10.3390/biomedicines11102637] [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: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
From the first reports of SARS-CoV-2, at the end of 2019 to the present, the global mortality associated with COVID-19 has reached 6,952,522 deaths as reported by the World Health Organization (WHO). Early intubation and mechanical ventilation can increase the survival rate of critically ill patients. This prospective study was carried out on 885 patients in the ICU of Mureș County Clinical Hospital, Romania. After applying inclusion and exclusion criteria, a total of 54 patients were included. Patients were monitored during hospitalization and at 6-month follow-up. We analyzed the relationship between invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) and radiological changes on thoracic CT scans performed at 6-month follow-up and found no significant association. Regarding paraclinical analysis, there was a statistically significant association between patients grouped by IMV and ferritin level on day 1 of admission (p = 0.034), and between patients grouped by PaO2/FiO2 ratio with metabolic syndrome (p = 0.03) and the level of procalcitonin (p = 0.01). A significant proportion of patients with COVID-19 admitted to the ICU developed pulmonary fibrosis as observed at a 6-month evaluation. Patients with oxygen supplementation or mechanical ventilation require dynamic monitoring and radiological investigations, as there is a possibility of long-term pulmonary fibrosis that requires pharmacological interventions and finding new therapeutic alternatives.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540139 Targu Mures, Romania;
| | - Adina Roman
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Danusia Onișor
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Sergio Rareș Bandila
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Dragoș Florin Babă
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Iuliu Cocuz
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Anamaria Costan
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Dragoș Corău
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
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Miyake N, Igarashi Y, Nakae R, Mizobuchi T, Masuno T, Yokobori S. Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study. BMC Pulm Med 2023; 23:251. [PMID: 37430221 DOI: 10.1186/s12890-023-02549-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS. METHODS This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group). RESULTS Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmH2O (95% confidence interval [CI], 0.20-0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8-20.2] vs. 9.3 [7.3-10.2], respectively). For peak pressure, the median difference was -0.30 cmH2O (95% CI, -0.30 - -0.20) (20.4 [17.0-24.4] in the ALS group vs. 20.9 [16.7-24.6] in the non-ALS group). The mean pressure difference of 0.0 cmH2O (95% CI, 0.0-0.0) (12.7 [10.9-14.6] vs. 13.0 [10.3-15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70-0.72) (8.17 [6.79-9.54] vs. 7.43 [6.03-8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmH2O (95% CI, 12.76-21.95) (43.8 [28.2-68.8] vs. 35.7 [26.5-41.5], respectively); both were higher in the ALS group than in the non-ALS group. CONCLUSIONS There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development.
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Affiliation(s)
- Nodoka Miyake
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Gerovasileiou E, Menis AA, Gavriilidis G, Magira E, Temperikidis P, Papoti S, Karavidas N, Spanos M, Zakynthinos E, Makris D. Risk Factors for Weaning Failure in COVID-19 Patients. J Crit Care Med (Targu Mures) 2023; 9:170-177. [PMID: 37588182 PMCID: PMC10425926 DOI: 10.2478/jccm-2023-0021] [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: 10/22/2022] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
Background Data on risk factors associated with mechanical ventilation (MV) weaning failure among SARS-CoV2 ARDS patients is limited. We aimed to determine clinical characteristics associated with weaning outcome in SARS-CoV2 ARDS patients under MV. Objectives To determine potential risk factors for weaning outcome in patients with SARS-CoV2 ARDS. Methods A retrospective observational study was conducted in the ICUs of four Greek hospitals via review of the electronic medical record for the period 2020-2021. All consecutive adult patients were screened and were included if they fulfilled the following criteria: a) age equal or above 18 years, b) need for MV for more than 48 hours and c) diagnosis of ARDS due to SARS-CoV2 pneumonia or primary or secondary ARDS of other aetiologies. Patient demographic and clinical characteristics were recorded for the first 28 days following ICU admission. The primary outcome was weaning success defined as spontaneous ventilation for more than 48 hours. Results A hundred and fifty eight patients were included; 96 SARS-CoV2 ARDS patients. SOFA score, Chronic Obstructive Pulmonary Disease (COPD) and shock were independently associated with the weaning outcome OR(95% CI), 0.86 (0.73-0.99), 0.27 (0.08-0.89) and 0.30 (0.14-0.61), respectively]. When we analysed data from SARS-CoV2 ARDS patients separately, COPD [0.18 (0.03-0.96)] and shock [0.33(0.12 - 0.86)] were independently associated with the weaning outcome. Conclusions The presence of COPD and shock are potential risk factors for adverse weaning outcome in SARS-CoV2 ARDS patients.
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Affiliation(s)
| | | | | | - Eleni Magira
- Evangelismos Athens General Hospital, Athens, Greece
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9
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Ergün B, Yakar MN, Küçük M, Baghiyeva N, Emecen AN, Yaka E, Ergan B, Gökmen AN. Combined Effects of Prone Positioning and Airway Pressure Release Ventilation on Oxygenation in Patients with COVID-19 ARDS. Turk J Anaesthesiol Reanim 2023; 51:188-198. [PMID: 37455436 DOI: 10.4274/tjar.2022.22783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). Invasive mechanical ventilation (IMV) support and prone positioning are essential treatments for severe COVID-19 ARDS. We aimed to determine the combined effect of prone position and airway pressure release ventilation (APRV) modes on oxygen improvement in mechanically-ventilated patients with COVID-19. Methods This prospective observational study included 40 eligible patients (13 female, 27 male). Of 40 patients, 23 (57.5%) were ventilated with APRV and 17 (42.5%) were ventilated with controlled modes. A prone position was applied when the PaO2/FiO2 ratio <150 mmHg despite IMV in COVID-19 ARDS. The numbers of patients who completed the first, second, and third prone were 40, 25, and 15, respectively. Incident barotrauma events were diagnosed by both clinical findings and radiological images. Results After the second prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [189 (150-237)] vs. 127 (100-146) mmHg, respectively, (P=0.025). Similarly, after the third prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [194 (132-263)] vs. 83 (71-136) mmHg, respectively, (P=0.021). Barotrauma events were detected in 13.0% of the patients in the APRV group and 11.8% of the patients in the control group (P=1000). The 28-day mortality was not different in the APRV group than in the control group (73.9% vs. 70.6%, respectively, P=1000). Conclusion Using the APRV mode during prone positioning improves oxygenation, especially in the second and third prone positions, without increasing the risk of barotrauma. However, no benefit on mortality was detected.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nuri Yakar
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Narmin Baghiyeva
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Naci Emecen
- Department of Public Health, Epidemiology Subsection, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Erdem Yaka
- Department of Neurology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ali Necati Gökmen
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Serck N, Piagnerelli M, Augy JL, Annoni F, Ottavy G, Courcelle R, Carbutti G, Lejeune F, Vinsonneau C, Sauneuf B, Lefebvre L, Higny J, Grimaldi D, Lascarrou JB. Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database. BMC Anesthesiol 2023; 23:138. [PMID: 37106345 PMCID: PMC10133898 DOI: 10.1186/s12871-023-02093-1] [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: 11/14/2022] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Despite evidence suggesting a higher risk of barotrauma during COVID-19-related acute respiratory distress syndrome (ARDS) compared to ARDS due to other causes, data are limited about possible associations with patient characteristics, ventilation strategy, and survival. METHODS This prospective observational multicenter study included consecutive patients with moderate-to-severe COVID-19 ARDS requiring invasive mechanical ventilation and managed at any of 12 centers in France and Belgium between March and December 2020. The primary objective was to determine whether barotrauma was associated with ICU mortality (censored on day 90), and the secondary objective was to identify factors associated with barotrauma. RESULTS Of 586 patients, 48 (8.2%) experienced barotrauma, including 35 with pneumothorax, 23 with pneumomediastinum, 1 with pneumoperitoneum, and 6 with subcutaneous emphysema. Median time from mechanical ventilation initiation to barotrauma detection was 3 [0-17] days. All patients received protective ventilation and nearly half (23/48) were in volume-controlled mode. Barotrauma was associated with higher hospital mortality (P < 0.001) even after adjustment on age, sex, comorbidities, PaO2/FiO2 at intubation, plateau pressure at intubation, and center (P < 0.05). The group with barotrauma had a lower mean body mass index (28.6 ± 5.8 vs. 30.3 ± 5.9, P = 0.03) and a higher proportion of patients given corticosteroids (87.5% vs. 63.4%, P = 0.001). CONCLUSION Barotrauma during mechanical ventilation for COVID-19 ARDS was associated with higher hospital mortality.
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Affiliation(s)
- Nicolas Serck
- Unité de soins intensifs, Clinique Saint Pierre, Ottignies, Belgium
| | - Michael Piagnerelli
- Intensive Care. CHU-Charleroi, Marie Curie, Université Libre de Brussels, 140, chaussée de Bruxelles, Charleroi, 6042, Belgium
| | - Jean Loup Augy
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Paris, France
| | - Filippo Annoni
- Soins Intensifs, H.UB, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Gregoire Ottavy
- Médecine Intensive Réanimation, CHU Nantes, 30 Boulevard Jean Monnet, Nantes Cedex 9, 44093, France
| | - Romain Courcelle
- Unité de soins intensifs, Centres Hospitaliers de Jolimont, La Louvière, Belgium
| | | | - Francois Lejeune
- Unité de soins intensifs, Clinique Notre Dame de Grâce, Gosselies, Belgium
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Unité de Sevrage Ventilatoire et Réhabilitation, Centre Hospitalier de Béthune, 27 Rue Delbecque, Beuvry, 62660, France
| | - Bertrand Sauneuf
- Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, BP208, 50102, France
| | - Laurent Lefebvre
- Réanimation polyvalente, Centre Hospitalier du pays d'Aix, Aix en Provence, France
| | - Julien Higny
- Unité de soins intensifs, CHU Dinant Godinne, site Dinant, Belgium
| | - David Grimaldi
- Soins Intensifs, H.UB, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, CHU Nantes, 30 Boulevard Jean Monnet, Nantes Cedex 9, 44093, France.
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Zanelli S, Bakakos A, Sotiropoulou Z, Papaioannou AI, Koukaki E, Potamianou E, Kyriakoudi A, Kaniaris E, Bakakos P, Giamarellos-Bourboulis EJ, Koutsoukou A, Rovina N. Modified SCOPE (mSCOPE) Score as a Tool to Predict Mortality in COVID-19 Critically Ill Patients. J Pers Med 2023; 13:jpm13040628. [PMID: 37109014 PMCID: PMC10146219 DOI: 10.3390/jpm13040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Efficient clinical scores predicting the outcome of severe COVID-19 pneumonia may play a pivotal role in patients’ management. The aim of this study was to assess the modified Severe COvid Prediction Estimate score (mSCOPE) index as a predictor of mortality in patients admitted to the ICU due to severe COVID-19 pneumonia. Materials and methods: In this retrospective observational study, 268 critically ill COVID-19 patients were included. Demographic and laboratory characteristics, comorbidities, disease severity, and outcome were retrieved from the electronical medical files. The mSCOPE was also calculated. Results: An amount of 70 (26.1%) of patients died in the ICU. These patients had higher mSCOPE score compared to patients who survived (p < 0.001). mSCOPE correlated to disease severity (p < 0.001) and to the number and severity of comorbidities (p < 0.001). Furthermore, mSCOPE significantly correlated with days on mechanical ventilation (p < 0.001) and days of ICU stay (p = 0.003). mSCOPE was found to be an independent predictor of mortality (HR:1.219, 95% CI: 1.010–1.471, p = 0.039), with a value ≥ 6 predicting poor outcome with a sensitivity (95%CI) 88.6%, specificity 29.7%, a positive predictive value of 31.5%, and a negative predictive value of 87.7%. Conclusion: mSCOPE score could be proved useful in patients’ risk stratification, guiding clinical interventions in patients with severe COVID-19.
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Affiliation(s)
- Stavroula Zanelli
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Agamemnon Bakakos
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Zoi Sotiropoulou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Andriana I. Papaioannou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelia Koukaki
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Efstathia Potamianou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Anna Kyriakoudi
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelos Kaniaris
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Petros Bakakos
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” Hospital, 12462 Athens, Greece
| | - Antonia Koutsoukou
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
| | - Nikoletta Rovina
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, 11527 Athens, Greece
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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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13
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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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14
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Bongiovanni F, Michi T, Natalini D, Grieco DL, Antonelli M. Advantages and drawbacks of helmet noninvasive support in acute respiratory failure. Expert Rev Respir Med 2023; 17:27-39. [PMID: 36710082 DOI: 10.1080/17476348.2023.2174974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) represents an effective strategy for managing acute respiratory failure. Facemask NIV is strongly recommended in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnia and acute cardiogenic pulmonary edema (ACPE). Its role in managing acute hypoxemic respiratory failure (AHRF) remains a debated issue. NIV and continuous positive airway pressure (CPAP) delivered through the helmet are recently receiving growing interest for AHRF management. AREAS COVERED In this narrative review, we discuss the clinical applications of helmet support compared to the other available noninvasive strategies in the different phenotypes of acute respiratory failure. EXPERT OPINION Helmets enable the use of high positive end-expiratory pressure, which may protect from self-inflicted lung injury: in AHRF, the possible superiority of helmet support over other noninvasive strategies in terms of clinical outcome has been hypothesized in a network metanalysis and a randomized trial, but has not been confirmed by other investigations and warrants confirmation. In AECOPD patients, helmet efficacy may be inferior to that of face masks, and its use prompts caution due to the risk of CO2 rebreathing. Helmet support can be safely applied in hypoxemic patients with ACPE, with no advantages over facemasks.
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Affiliation(s)
- Filippo Bongiovanni
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Teresa Michi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Daniele Natalini
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Domenico L Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
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15
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Iatrogenic Barotrauma in COVID-19-Positive Patients: Is It Related to the Pneumonia Severity? Prevalence and Trends of This Complication Over Time. Biomedicines 2022; 10:biomedicines10102493. [PMID: 36289754 PMCID: PMC9598729 DOI: 10.3390/biomedicines10102493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 has attracted worldwide attention ever since the first case was identified in Wuhan (China) in December 2019 and was classified, at a later time, as a public health emergency of international concern in January 2020 and as a pandemic in March 2020. The interstitial pneumonia caused by COVID-19 often requires mechanical ventilation, which can lead to pulmonary barotrauma. We assessed the relationship between pneumonia severity and the development of barotrauma in COVID-19-positive patients mechanically ventilated in an intensive care unit; we therefore analyzed the prevalence of iatrogenic barotrauma and its trends over time during the pandemic in COVID-19-positive patients undergoing mechanical ventilation compared to COVID-19-negative patients, making a distinction between different types of ventilation (invasive mechanical ventilation vs. noninvasive mechanical ventilation). We compared CT findings of pneumomediastinum and pneumothorax in 104 COVID-19-positive patients hospitalized in an intensive care unit and 101 COVID-19-negative patients undergoing mechanical ventilation in the period between October 2020 and December 2021. The severity of pneumonia was not directly correlated with the development of barotrauma. Furthermore, a higher prevalence of complications due to barotrauma was observed in the group of mechanically ventilated COVID-19-postive patients vs. COVID-19-negative patients. A higher rate of barotrauma was observed in subgroups of COVID-19-positive patients undergoing mechanical ventilation compared to those treated with invasive mechanical ventilation. The prevalence of barotrauma in COVID 19-positive patients showed a decreasing trend over the period under review. CT remains an essential tool in the early detection, diagnosis, and monitoring of the clinical course of SARS-CoV2 pneumonia; in evaluating the disease severity; and in the assessment of iatrogenic complications such as barotrauma pathology.
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16
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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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17
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Milovac T. Understanding chronic Covid-19. EClinicalMedicine 2022; 51:101552. [PMID: 35844768 PMCID: PMC9271905 DOI: 10.1016/j.eclinm.2022.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 11/01/2022] Open
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18
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Koukaki E, Rovina N, Tzannis K, Sotiropoulou Z, Loverdos K, Koutsoukou A, Dimopoulos G. Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients. J Fungi (Basel) 2022; 8:jof8080881. [PMID: 36012869 PMCID: PMC9410292 DOI: 10.3390/jof8080881] [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: 07/31/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: COVID-19-associated fungal infections seem to be a concerning issue. The aim of this study was to assess the incidence of fungal infections, the possible risk factors, and their effect on outcomes of critically ill patients with COVID-19. Methods: A retrospective observational study was conducted in the COVID-19 ICU of the First Respiratory Department of National and Kapodistrian University of Athens in Sotiria Chest Diseases Hospital between 27 August 2020 and 10 November 2021. Results: Here, 178 patients were included in the study. Nineteen patients (10.7%) developed fungal infection, of which five had COVID-19 associated candidemia, thirteen had COVID-19 associated pulmonary aspergillosis, and one had both. Patients with fungal infection were younger, had a lower Charlson Comorbidity Index, and had a lower PaO2/FiO2 ratio upon admission. Regarding health-care factors, patients with fungal infections were treated more frequently with Tocilizumab, a high regimen of dexamethasone, continuous renal replacement treatment, and were supported more with ECMO. They also had more complications, especially infections, and subsequently developed septic shock more frequently. Finally, patients with fungal infections had a longer length of ICU stay, as well as length of mechanical ventilation, although no statistically significant difference was reported on 28-day and 90-day mortality. Conclusions: Fungal infections seem to have a high incidence in COVID-19 critically ill patients and specific risk factors are identified. However, fungal infections do not seem to burden on mortality.
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Affiliation(s)
- Evangelia Koukaki
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
| | - Nikoletta Rovina
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kimon Tzannis
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Zoi Sotiropoulou
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Loverdos
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonia Koutsoukou
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Dimopoulos
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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19
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Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil. J Crit Care Med (Targu Mures) 2022; 8:165-175. [PMID: 36062038 PMCID: PMC9396953 DOI: 10.2478/jccm-2022-0015] [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] [Received: 12/12/2021] [Accepted: 06/12/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Introduction
The use of invasive mechanical ventilation (IMV) in COVID-19 represents in an incremental burden to healthcare systems.
Aim of the study
We aimed to characterize patients hospitalized for COVID-19 who received IMV and identify risk factors for mortality in this population.
Material and Methods
A retrospective cohort study including consecutive adult patients admitted to a private network in Brazil who received IMV from March to October, 2020. A bidirectional stepwise logistic regression analysis was used to determine the risk factors for mortality.
Results
We included 215 patients, of which 96 died and 119 were discharged from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p<0.001, and a shorter duration from symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). Multivariable regression analysis showed that the risk factors for mortality were age (OR: 1.07, 95% CI: 1.03 to 1.1, p < 0.001), creatinine level at the intubation date (OR: 3.28, 95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006).
Conclusion
In our retrospective cohort we identified the main risk factors for mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to intubation.
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20
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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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21
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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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22
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Niu BY, Wang G, Li B, Zhen GS, Weng YB. Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics. World J Clin Cases 2022; 10:7314-7323. [PMID: 36157993 PMCID: PMC9353906 DOI: 10.12998/wjcc.v10.i21.7314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/17/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance, alveolar capillary injury, pulmonary edema, refractory hypoxemia, and reduced lung compliance. Prolonged hypoxia can cause acid-base balance disorder, peripheral circulatory failure, blood-pressure reduction, arrhythmia, and other adverse consequences.
AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.
METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial, with each group comprising 54 patients. The sequential group received invasive and non-invasive sequential mechanical ventilation, whereas the regular group received invasive mechanical ventilation. Blood-gas parameters, hemodynamic parameters, respiratory mechanical parameters, inflammatory factors, and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.
RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24, 48, and 72 h of treatment were higher than those of the conventional group (P < 0.05). The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group (P < 0.05). The pH value of the sequential group at 24 and 72 h of treatment, the central venous pressure value of the treatment at 24 h, and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group (P < 0.05). The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group (P < 0.05), the measured values of interleukin-6 and tumor necrosis factor-α in the sequential group at 72 h of treatment were lower than those in the conventional group (P < 0.05), and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group, with a statistically significant difference (P < 0.05).
CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance, reducing inflammatory response, maintaining hemodynamic stability, and improving patient blood-gas levels; however, from this study’s perspective, it cannot reduce patient mortality.
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Affiliation(s)
- Bing-Yin Niu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Guan Wang
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Bin Li
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Gen-Shen Zhen
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Yi-Bing Weng
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
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23
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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] [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
- *Correspondence: Penny Andrews,
| | - 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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24
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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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25
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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: 24] [Impact Index Per Article: 12.0] [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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Bocchino M, Lieto R, Romano F, Sica G, Bocchini G, Muto E, Capitelli L, Sequino D, Valente T, Fiorentino G, Rea G. Chest CT-based Assessment of 1-year Outcomes after Moderate COVID-19 Pneumonia. Radiology 2022; 305:479-485. [PMID: 35536134 PMCID: PMC9619196 DOI: 10.1148/radiol.220019] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background COVID-19 pneumonia may lead to pulmonary fibrosis in the long term. Chest CT is useful to evaluate changes in the lung parenchyma over time. Purpose To illustrate the temporal change of lung abnormalities on chest CT scans associated with COVID-19 pneumonia over 1 year. Materials and Methods In this prospective study, patients previously hospitalized due to COVID-19 pneumonia who visited the radiology department of a tertiary care center for imaging follow-up were consecutively enrolled between March 2020 and July 2021. Exclusion criteria were acute respiratory distress syndrome, requirement of intubation and/or mechanical ventilation, pulmonary embolism, and any interstitial lung disease. High-resolution volumetric noncontrast chest CT scans were acquired at 3, 6, and 12 months from the first diagnosis and were compared with baseline CT scans. The imaging features analyzed were ground-glass opacity (GGO), consolidation, pleuroparenchymal band, linear atelectasis, bronchiectasis and/or bronchiolectasis, reticulation, traction bronchiectasis and/or bronchiolectasis, and honeycombing. The prevalence distribution of lung abnormalities was recorded at all time points. Results Eighty-four participants (56 men; mean age, 61 years ± 11 [SD]) were studied. GGOs and consolidations represented the main baseline lung abnormalities, accounting for a median severity score of 9 (IQR, 7–12.7; maximum possible score, 20), which indicates moderate lung involvement. The baseline prevalence of GGOs decreased from 100% to 2% of participants at 1 year, and that of consolidations decreased from 71% to 0% at 6 months. Fibrotic-like abnormalities (pleuroparenchymal bands, linear atelectasis, bronchiectasis and/or bronchiolectasis) were detected at 3 months (50% of participants), 6 months (42% of participants), and 1 year (5% of participants). Among these, pleuroparenchymal bands were the most represented finding. Fibrotic changes (reticulation and traction bronchiectasis and/or bronchiolectasis) were detected at 3–6 months (2%) and remained stable at 1 year, with no evidence of honeycombing. At 1 year, lung abnormalities due to COVID-19 pneumonia were completely resolved in 78 of 84 (93%) participants. Conclusion Residual lung abnormalities in individuals hospitalized with moderate COVID-19 pneumonia were infrequent, with no evidence of fibrosis at 1-year chest CT. © RSNA, 2022
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Affiliation(s)
- Marialuisa Bocchino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Emanuele Muto
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Ludovica Capitelli
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Davide Sequino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giuseppe Fiorentino
- Pathophysiology and Respiratory Rehabilitation Department of Critical Area, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
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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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28
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Shrestha DB, Sedhai YR, Budhathoki P, Adhikari A, Pokharel N, Dhakal R, Kafle S, Yadullahi Mir WA, Acharya R, Kashiouris MG, Parker MS. Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 73:103221. [PMID: 35003730 PMCID: PMC8721930 DOI: 10.1016/j.amsu.2021.103221] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data. METHODS A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3. RESULTS We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS. CONCLUSION COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.
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Affiliation(s)
| | - Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Pravash Budhathoki
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Ayush Adhikari
- Department of Anesthesia and Critical Care, TU Teaching Hospital, Kathmandu, Nepal
| | - Nisheem Pokharel
- Department of Internal Medicine, KIST Medical College, Lalitpur, Nepal
| | - Richa Dhakal
- Department of Internal Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Satyasuna Kafle
- Department of Intensive Care Unit, Bhaktapur Hospital, Bhaktapur, Nepal
| | | | - Roshan Acharya
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, USA
| | - Markos G. Kashiouris
- Department of Internal Medicine, Pulmonary and Critical Care, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Mark S. Parker
- Department of Radiology, Division of Thoracic Imaging, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
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29
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Ibrahim GS, Alkandari BM, Shady IAA, Gupta VK, Abdelmohsen MA. Invasive mechanical ventilation complications in COVID-19 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8450704 DOI: 10.1186/s43055-021-00609-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Since late 2019, COVID-19 infection has quickly spread substantially in all countries, forcing the appropriation of noteworthy lockdown and social separating measures. It has been considered as a pandemic by the World Health Organization. Positive pressure ventilation is a non-physiological and invasive intervention that can be lifesaving in COVID-19 patients. Similar to any other interventions, it can cause its own danger and complications as it can prompt ventilator-induced lung injury and barotrauma. The aim of the work was to identify the incidence of invasive mechanical ventilation complication in COVID-19 pneumonias, and to describe patient characteristics and patterns of barotrauma in COVID-19 patients. Results This retrospective study included 103 patients with COVID-19 pneumonia, 76 males and 27 females are on invasive mechanical ventilation. Their mean age was 56.6, ranged from 21 to 85 years old. Barotraumas event type in the studied patients, (NB: one or multiple barotrauma events occurring on the same day were considered as single event (95/103 patients-92.23%), while separate multiple events (8/103 patients-7.77%) were recorded when occurring separated by at least 24 h). Single barotrauma events were subdivided into: one event (67/95 patients—70.53%), & multiple events (28/95 patients—29.47%). The mean interval between invasive mechanical ventilation and developing barotraumas was 3–7 days included 41 patients (39.98%). We revealed a strong prevalence of COVID-19 IMV complication with worsening prognosis and subsequent higher death rates in elderly smoker or obese males, as well as those suffering from ARDS. Past medical history (hypertension, DM, chronic renal or cardiac disease) or surgical history of CABG was more liable for these types of complications. Conclusion Patients with COVID-19 pneumonia were more liable to the higher incidence of barotraumas with presence of predisposition and high risk factors. In general, an outstanding bad prognostic outcome and a significantly high mortality rate prevailed in COVID-19 patients associated with mechanically ventilated patients.
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30
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Isasi F, Naylor MD, Skorton D, Grabowski DC, Hernández S, Rice VM. Patients, Families, and Communities COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2021; 2021:202111c. [PMID: 35118349 PMCID: PMC8803391 DOI: 10.31478/202111c] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Mary D Naylor
- NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing
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31
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Jones L, Nightingale R, Burhan H, Jones G, Barber K, Bond H, Parker R, Duffy N, Hampshire P, Gautam M. Is continuous positive airway pressure therapy in COVID-19 associated with an increased rate of pulmonary barotrauma? ERJ Open Res 2021; 7:00886-2020. [PMID: 34703829 PMCID: PMC8310957 DOI: 10.1183/23120541.00886-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has infected over 150 million people worldwide, with over 3 million deaths as of 6 May 2021 [1]. In the UK, approximately 15% of individuals affected by coronavirus disease 2019 (COVID-19) have required admission to hospital [2] and those with severe disease require advanced respiratory support including invasive mechanical ventilation (IMV) [3]. Due to the considerable scale of the pandemic, noninvasive continuous positive airway pressure (CPAP) has been utilised for COVID-19-related type I respiratory failure as a therapeutic strategy to improve patient outcomes [4, 5] and also to preserve IMV capacity during a challenging time for acute healthcare providers. However, its exact role is unclear and is the subject of a UK multicentre trial [6]. An increased incidence of pulmonary barotrauma in patients receiving CPAP for #COVID19 pneumonia was observed during the second peak of infections at this centre in the UKhttps://bit.ly/3qeSTp9
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Affiliation(s)
- Lewis Jones
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Rebecca Nightingale
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gareth Jones
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Kimberley Barber
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Helena Bond
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Robert Parker
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Nick Duffy
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter Hampshire
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
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32
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Gutierrez-Ariza JC, Rodriguez Yanez T, Martinez-Ávila MC, Almanza Hurtado A, Dueñas-Castell C. Pneumomediastinum and Pneumothorax Following Non-invasive Respiratory Support in Patients With Severe COVID-19 Disease. Cureus 2021; 13:e18796. [PMID: 34796074 PMCID: PMC8590743 DOI: 10.7759/cureus.18796] [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] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic led to an increased number of patients with pneumothorax and pneumomediastinum owing to complications attributed to viral pneumonia regardless of the use of mechanical invasive ventilation and the elapsed time of infection. The pathophysiology remains unknown. However, the Macklin effect is shown as the most plausible mechanism along with possible barotrauma secondary to a high-flow nasal cannula and noninvasive mechanical ventilation. We present two cases of patients who developed pneumomediastinum and tension pneumothorax. One of the patients was studied during infection and the other after recovery. Both received appropriate and timely treatments with successful outcomes. It is important to be aware of these potentially fatal complications as early management can reduce the associated morbidity and mortality.
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33
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Reis AE, Emami N, Chand S, Ogundipe F, Belkin DL, Ye K, Keene AB, Levsky JM. Epidemiology, Risk Factors and Outcomes of Pneumomediastinum in Patients with Coronavirus Disease 2019: A Case-Control Study. J Intensive Care Med 2021; 37:12-20. [PMID: 34515571 DOI: 10.1177/08850666211040417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Since the beginning of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, pneumomediastinum has been reported in patients with COVID-19 pneumonia and acute respiratory distress syndrome. It has been suggested that pneumomediastinum may portend a worse outcome in such patients although no investigation has established this association definitively. Research Question: We hypothesized that the finding of pneumomediastinum in the setting of COVID-19 disease may be associated with a worse clinical outcome. The purpose of this study was to determine if the presence of pneumomediastinum was predictive of increased mortality in patients with COVID-19. Study Design and Methods: A retrospective case-control study utilizing clinical data and imaging for COVID-19 patients seen at our institution from 3/7/2020 to 5/20/2020 was performed. 87 COVID-19 positive patients with pneumomediastinum were compared to 87 COVID-19 positive patients without pneumomediastinum and to a historical group of patients with pneumomediastinum during the same time frame in 2019. Results: The incidence of pneumomediastinum was increased more than 6-fold during the COVID-19 pandemic compared to 2019 (P = <.001). 1.5% of all COVID-19 patients and 11% of mechanically ventilated COVID-19 patients at our institution developed pneumomediastinum. Patients who developed pneumomediastinum had a significantly higher PEEP and lower P/F ratio than those who did not (P = .002 and .033, respectively). Pneumomediastinum was not found to be associated with increased mortality (P = .16, confidence interval [CI]: 0.89-2.09, 1.37). The presence of concurrent pneumothorax at the time of pneumomediastinum diagnosis was associated with increased mortality (P = .013 CI: 1.15-3.17, 1.91). Conclusion: Pneumomediastinum is not independently associated with a worse clinical prognosis in COVID-19 positive patients. The presence of concurrent pneumothorax was associated with increased mortality.
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Affiliation(s)
- Alexandra E Reis
- Division of Cardiothoracic Imaging, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Nader Emami
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Sudham Chand
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Funmilola Ogundipe
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Daniel L Belkin
- Division of Cardiothoracic Imaging, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Kenny Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, The Bronx, USA.,Department of Systems and Computational Biology, Albert Einstein College of Medicine, The Bronx, USA
| | - Adam B Keene
- Division of Cardiothoracic Imaging, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Jeffrey M Levsky
- Division of Cardiothoracic Imaging, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA.,Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
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34
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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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35
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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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36
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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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37
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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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38
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Sami R, Sereshti N. Case Report: Barotrauma in COVID-19 Case Series. Am J Trop Med Hyg 2021; 105:54-58. [PMID: 34003793 PMCID: PMC8274782 DOI: 10.4269/ajtmh.21-0080] [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] [Received: 01/25/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 can cause pulmonary complications, such as increased risk of barotrauma (BT), but its prevalence and risk factors are not known. In this case series, the course of BT and its related risk factors were discussed in patients with COVID-19 who were admitted to the intensive care unit. Medical records of the patients with COVID-19 and BT and hospitalized in the intensive care unit for 5 months were extracted. The course of BT and its possible associated risk factors are descriptively presented. Among 103 patients with COVID-19 who were intubated, 13 patients (12.6%) had BT. One patient developed BT before intubation. All patients with BT were male. Half of them developed BT in the first 5 days of intubation. Eight patients (61.53%) had a positive culture for Klebsiella pneumoniae. Nine patients (69.9%) died. High positive end-expiratory pressure, coinfection with bacterial pneumonia, and history of lung disease may affect BT incidence. The treatment team should increase their upervision on the ventilator setting, especially in the first week of intubation.
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Affiliation(s)
- Ramin Sami
- 1Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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39
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Brogna B, Bignardi E, Brogna C, Volpe M, Lombardi G, Rosa A, Gagliardi G, Capasso PFM, Gravino E, Maio F, Pane F, Picariello V, Buono M, Colucci L, Musto LA. A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia. Diagnostics (Basel) 2021; 11:437. [PMID: 33806423 PMCID: PMC8000129 DOI: 10.3390/diagnostics11030437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays an important role in the detection of coronavirus (COVID-19) pneumonia in both managing the disease and evaluating the complications. Imaging with chest computed tomography (CT) can also have a potential predictive and prognostic role in COVID-19 patient outcomes. The aim of this pictorial review is to describe the role of imaging with chest X-ray (CXR), lung ultrasound (LUS), and CT in the diagnosis and management of COVID-19 pneumonia, the current indications, the scores proposed for each modality, the advantages/limitations of each modality and their role in detecting complications, and the histopathological correlations.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Elio Bignardi
- Radiology Unit, Cotugno Hospital, Naples, Via Quagliariello 54, 80131 Naples, Italy;
| | - Claudia Brogna
- Neuropsychiatric Unit ASL Avellino, Via Degli Imbimbo 10/12, 83100 Avellino, Italy;
| | - Mena Volpe
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Giulio Lombardi
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Alessandro Rosa
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Giuliano Gagliardi
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Pietro Fabio Maurizio Capasso
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Enzo Gravino
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Francesca Maio
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Francesco Pane
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Valentina Picariello
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Marcella Buono
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Lorenzo Colucci
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Lanfranco Aquilino Musto
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
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40
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Eroglu A. Barotrauma in mechanically ventilated patients with COVID-19. Minerva Anestesiol 2021; 87:144-146. [PMID: 33432799 DOI: 10.23736/s0375-9393.20.15378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ahmet Eroglu
- Faculty of Medicine, Anesthesiology and Reanimation, Karadeniz Technical University, Trabzon, Turkey -
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41
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Mart MF, Norfolk SG, Flemmons LN, Stokes JW, Bacchetta MD, Trindade AJ, Casey JD, Semler MW, Ely EW, Noto MJ. Pneumomediastinum in Acute Respiratory Distress Syndrome from COVID-19. Am J Respir Crit Care Med 2021; 203:237-238. [PMID: 33448891 PMCID: PMC7874420 DOI: 10.1164/rccm.202008-3376im] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship Center
| | | | | | - John W Stokes
- Department of Thoracic Surgery, and
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D Bacchetta
- Department of Thoracic Surgery, and
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Critical Illness, Brain Dysfunction, and Survivorship Center
| | - Michael J Noto
- Division of Allergy, Pulmonary, and Critical Care Medicine
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42
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Edwards JA, Breitman I, Bienstock J, Badami A, Kovatch I, Dresner L, Schwartzman A. Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: A case series. Ann Med Surg (Lond) 2020; 61:24-29. [PMID: 33363723 PMCID: PMC7750442 DOI: 10.1016/j.amsu.2020.11.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in hypoxic respiratory failure necessitating mechanical ventilation. Barotrauma is a well-documented complication of mechanical ventilation. Objective To describe the presentation, characteristics, and management of mechanically ventilated patients with COVID-19 who developed barotrauma. Methods Retrospective case series study of 13 adult, mechanically ventilated, laboratory-confirmed COVID-19 positive patients admitted between 3/15/2020 and 4/14/2020 to a community hospital in New York City. Patient demographics, clinical course, ventilatory parameters, and radiographic results were obtained from electronic medical records. Barotrauma was defined as pneumomediastinum, subcutaneous emphysema, and or pneumothorax on chest X-ray. Descriptive analyses and Mann-Whitney U test were performed, where appropriate. Results Of the 574 COVID-19 positive patients, 139 (24.2%) needed mechanical ventilation and 13 (9.4%) of those developed barotrauma. Majority of patients were Black race (92.3%), older than age 65 (56.8%), male (69.2%), and had comorbidities (76.9%). Most common presenting symptoms were cough (84.6%) and dyspnea (76.9%). Barotrauma presentations included 3/13 pneumothoraces and pneumomediastinum, 12/13 pneumomediastinum and subcutaneous emphysema, and 1/13 pneumothorax alone. The average days on ventilator was 3.4, average positive expiratory-end pressure 15.5 cmH2O, dynamic compliance 33.8 mL/cmH2O, and P/F ratio 165. Interventions were 4/13 chest tubes and 2/13 pigtail catheters. Conclusions Barotrauma is a common complication of mechanical ventilation of COVID-19 patients. Despite high ventilatory pressures, tension pneumothorax is rare and barotrauma could potentially be managed conservatively. Further studies are needed to evaluate the indication and outcome of thoracostomies and conservative management. Pulmonary barotrauma is a risk of mechanical ventilation. Many patients with COVID-19 pneumonia require mechanical ventilation. Patients with COVID-19 pneumonia are susceptible to pulmonary barotrauma.
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