1
|
Negri S, Mazzuca E, Lococo F, Mondoni M, Covino M, Kuzmych K, Agati S, Amata M, Arcoleo G, Gabbrielli L, Pancani R, Tedeschi E, Baiamonte P, Sassu A, Patrucco F, Foci V, Marchetti G, Vernuccio F, Zanardi E, Gaccione AT, Sorino C. Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study. Respir Med 2024; 230:107684. [PMID: 38823564 DOI: 10.1016/j.rmed.2024.107684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND An increased incidence of pneumomediastinum has been observed among patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. The study aimed to identify risk factors for COVID-19-associated pneumomediastinum and investigate the impact of pneumomediastinum on clinical outcomes. METHODS In this multicentre retrospective case-control study, we included consecutive patients with COVID-19 pneumonia and pneumomediastinum hospitalized from March 2020 to July 2020 at ten centres; then, we identified a similarly sized control group of consecutive patients hospitalized with COVID-19 pneumonia and respiratory failure who did not develop pneumomediastinum during the same period. Clinical, laboratory, and radiological characteristics, as well as respiratory support and outcomes, were collected and compared between the two groups. Risk factors of pneumomediastinum were assessed by multivariable logistic analysis. RESULTS Overall 139 patients with pneumomediastinum and 153 without pneumomediastinum were analysed. Lung involvement ≥75 %, consolidations, body mass index (BMI) < 22 kg/m2, C-reactive protein (CRP) > 150 mg/L, D-dimer >3000 ng/mL FEUs, and smoking exposure >20 pack-year were all independently correlated with the occurrence of pneumomediastinum. Patients with pneumomediastinum had a longer hospital stay (mean ± SD 31.2 ± 20.2 days vs 19.6 ± 14.2, p < 0.001), higher intubation rate (73/139, 52.5 % vs 27/153, 17.6 %, p < 0.001), and in-hospital mortality (68/139, 48.9 % vs 36/153, 23.5 %, p < 0.001) compared to controls. CONCLUSIONS Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with a greater risk of pneumomediastinum in COVID-19 pneumonia. This complication significantly worsens the outcomes.
Collapse
Affiliation(s)
- Stefano Negri
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Emilia Mazzuca
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marcello Covino
- Emergency Department - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Agati
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Marta Amata
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ersilia Tedeschi
- Pulmonology, Ente Ecclesiastico Ospedale "F. Miulli" Acquaviva delle Fonti-Bari, Italy
| | | | - Alessandro Sassu
- Pulmonology and Semintensive Respiratory Unit, Ospedale Santissima Trinità, Cagliari, Italy
| | - Filippo Patrucco
- Pulmonology, Dipartimento Medico, AOU Maggiore della Carità di Novara, Italy
| | - Valentina Foci
- Pulmonology, Ospedali Riuniti di Livorno, Azienda Usl Toscana Nord-Ovest, Italy
| | | | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Erika Zanardi
- Pulmonology, Ospedale di Cittadella, AULSS6-Euganea, Padova, Italy
| | | | - Claudio Sorino
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy; Faculty of Medicine and Surgery, University of Insubria, Varese, Italy.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Al Lawati R, Al Lawati F, Al Battashi N, Al Umairi R, Al Ajmi E, Al Lawati N. Case Series on Barotrauma in COVID-19 Infection Patients. Oman Med J 2023; 38:e557. [PMID: 38192363 PMCID: PMC10772361 DOI: 10.5001/omj.2023.44] [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: 11/29/2021] [Accepted: 09/04/2022] [Indexed: 01/10/2024] Open
Abstract
As COVID-19 emerged in the world, there was a high prevalence of intubation and intensive care admissions. Many cases of barotrauma were reported in those patients. This condition is caused by alveoli rupture, which causes the air to enter the surrounding extra-alveolar spaces. It mainly happens in intubated patients. Here, we report 14 cases of barotrauma in COVID-19 patients, which appeared either spontaneously or after receiving non-invasive ventilation, some of the patients presented initially with mild-moderate forms of the disease in terms of severity. Developing barotrauma causes a management challenge in COVID-19 patients, where the patients might require invasive mechanical ventilation afterwards, which is a difficult situation. Lung protective measures should be used to reduce the risk of barotrauma in all patients as it is associated with increased mortality.
Collapse
Affiliation(s)
| | - Fatma Al Lawati
- Internal Medicine Department, Pulmonology Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Eiman Al Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nabil Al Lawati
- Chest and Sleep Medicine, COVID-19 Field Hospital, Muscat, Oman
| |
Collapse
|
4
|
Musat O, Sorop VB, Sorop MI, Lazar V, Marti DT, Susan M, Avram CR, Oprisoni A, Vulcanescu DD, Horhat FG, Bagiu IC, Horhat DI, Diaconu MM. COVID-19 and Laboratory Markers from Romanian Patients-A Narrative Review. Life (Basel) 2023; 13:1837. [PMID: 37763241 PMCID: PMC10532991 DOI: 10.3390/life13091837] [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: 07/25/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
COVID-19 has significantly impacted the whole world, and Romania was no exception. Biomarkers play a crucial role in understanding and managing the disease. However, research regarding laboratory analyses for patients with COVID-19 is fairly limited. For detection, PCR testing is still considered the golden standard, while antibodies are still useful for monitoring both patients and their vaccination status. In our country, biomarkers such as CRP, LDH, transaminases, cardiac, and iron markers have been used to assess the status of patients and even predict illness outcome. CRP, IL-6, LDH, FER, fibrinogen, creatinine, and vitamin D levels have been associated with increased severity, risk of ICU admission, and death. Cardiac markers and D-dimers are also good predictors, but their role seems more important in patients with complications. HDL cholesterol and BUN levels were also suggested as potential biomarkers. Hematological issues in SARS-CoV-2 infections include neutrophilia, lymphopenia and their ratio, while PCT, which is a marker of bacterial infections, is better to be used in patients with co- or supra-infections. The current research is a narrative review that focuses on the laboratory results of Romanian COVID-19 patients. The goal of this article is to provide an update on the research on biomarkers and other laboratory tests conducted inside the borders of Romania and identify gaps in this regard. Secondly, options for further research are discussed and encouraged.
Collapse
Affiliation(s)
- Ovidiu Musat
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania;
- Department of Ophthalmology, “Dr Carol Davila” Central Military Emergency University Hospital, Mircea Vulcanescu Street, No. 88, 010825 Bucharest, Romania
| | - Virgiliu Bogdan Sorop
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania; (V.B.S.); (M.M.D.)
| | - Madalina Ioana Sorop
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.I.S.); (D.D.V.)
| | - Viorica Lazar
- Department of General Medicine, “Vasile Goldis” University of Medicine, Liviu Rebreanu Street, No. 86, 310048 Arad, Romania;
- Pediatric Clinic II, Clinical Hospital Emergency of Arad County, Andrényi Károly Street, No. 2-4, 310037 Arad, Romania
| | - Daniela Teodora Marti
- Department of Biology and Life Sciences, “Vasile Goldis” University of Medicine, Liviu Rebreanu Street, No. 86, 310048 Arad, Romania;
- Clinical Analysis Laboratory Clinical Hospital Emergency of Arad County, Andrényi Károly Street, No. 2-4, 310037 Arad, Romania
| | - Monica Susan
- Department of Internal Medicine, Centre for Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Cecilia Roberta Avram
- Department of Residential Training and Post-University Courses, “Vasile Goldis” Western University, Liviu Rebreanu Street 86, 310414 Arad, Romania;
| | - Andrada Oprisoni
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Dan Dumitru Vulcanescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.I.S.); (D.D.V.)
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Clinical Analysis Laboratory, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Florin George Horhat
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Clinical Analysis Laboratory, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Iulia Cristina Bagiu
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Clinical Analysis Laboratory, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Delia Ioana Horhat
- Department of ENT, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Mircea Mihai Diaconu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania; (V.B.S.); (M.M.D.)
| |
Collapse
|
5
|
Murawska Baptista A, Sinclair De Frías J, Singh T, Vasudhar A, Guzzino J, Khalili W, Tekin A, Bansal V, Kashyap R, Joyce WJ, Lewis PA, Sanghavi D, Gavrancic T, Moreno Franco P. Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes. Expert Rev Respir Med 2023; 17:727-733. [PMID: 37675598 DOI: 10.1080/17476348.2023.2254689] [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: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020-06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE. RESULTS 1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19-21.59) and ICU admission of 9.14 (95%CI, 5.3-12.78) compared to the unaffected group. CONCLUSION Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.
Collapse
Affiliation(s)
| | | | - Trisha Singh
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ananya Vasudhar
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jacob Guzzino
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Waheed Khalili
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Aysun Tekin
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vikas Bansal
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - William J Joyce
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Patricia A Lewis
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Tatjana Gavrancic
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | |
Collapse
|
6
|
Khaire N, Deshmukh S, Agarwal E, Mahale N, Khaladkar S, Desai S, Kulkarni A. "Pneumomediastinum: A marker of severity in Covid-19 disease". Heliyon 2023; 9:e12981. [PMID: 36647393 PMCID: PMC9834123 DOI: 10.1016/j.heliyon.2023.e12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Objective The goal of this study was to look at the incidence, risk factors, clinical characteristics, and radiological aspects of COVID-19 patients who developed pneumomediastinum and compare these features between those who died and those who survived. Materials and methods This retrospective observational study included COVID-19 patients having pneumomediastinum on CT from May 2020 to May 2021 in a COVID-19 care hospital. 1st wave patients were considered between the period of May 2020 to January 2021 and those in the second wave between February 2021 to May 2021. The clinical details were analyzed by a consultant intensivist and CT scans were read by a team of 6 resident radiologists and 5 experienced radiologists. Demographic data, co-morbidities, clinical parameters, hemodynamic markers, radiological involvement and associated complications were analyzed. Results During the study period, 10,605 COVID-19 patients were admitted to our hospital of which 5689 underwent CT scan. 66 patients were detected to have pneumomediastinum on CT; 26 of them in the first wave and 40 in the second wave. Out of 66, 28 patients were admitted to ICU, 9 during the first wave and 18 during the second wave. The overall incidence of developing pneumomediastinum was 1.16%. Incidence in the 1st wave was 1.0% and in the 2nd wave was 1.29%. The overall mortality rate in admitted COVID-19 patients was 12.83% while it was 43.9% in COVID-19 patients who developed pneumomediastinum. Incidence of pneumomediastinum and pneumothorax was high in patients with extensive parenchymal involvement. 59/66 (89%) cases of pneumomediastinum had severe CT score on imaging. Conclusion We conclude that pneumomediastinum is a marker of poor prognosis. Timely diagnosis of interstitial emphysema or pneumomediastinum will aid in planning early protective ventilation strategies and timely intervention of complications.
Collapse
Affiliation(s)
- Nivedita Khaire
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sonali Deshmukh
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Esha Agarwal
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India,Corresponding author. Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Near Mhatre Bridge, Erandawne, Pune, India.411004.
| | - Nilesh Mahale
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sanjay Khaladkar
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sanjay Desai
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Ashwini Kulkarni
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| |
Collapse
|
7
|
Cut TG, Ciocan V, Novacescu D, Voicu A, Marinescu AR, Lazureanu VE, Muresan CO, Enache A, Dumache R. Autopsy Findings and Inflammatory Markers in SARS-CoV-2: A Single-Center Experience. Int J Gen Med 2022; 15:8743-8753. [PMID: 36597439 PMCID: PMC9805743 DOI: 10.2147/ijgm.s389300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose The systemic inflammatory response related to COVID-19 can be easily investigated in living patients. Unfortunately, not every biomarker is suitable for postmortem analysis since several factors may interfere. The aim of this study was to summarize key histopathological findings within each organ system due to COVID-19 and to assess if serological inexpensive and widely available biomarkers such as CRP, IL-6, fibrinogen and d-Dimers, associated with adverse outcomes in COVID-19, can be implemented in a post-mortem assessment. Patients and Methods A total of 60 subjects divided in 2 groups were included. All subjects died outside a hospital setting and therefore did not receive specific or symptomatic therapies that could have modulated the inflammatory response. The first group included 45 subjects in which mandatory autopsy was performed in order to establish the cause of death and macroscopic examination of the lungs was highly suggestive of SARS-CoV-2 infection. As controls (Group 2), 20 subjects who died from polytrauma in high velocity car accidents and suicide were selected. Bronchial fluids collected during the autopsy procedure were used for the RT-PCR diagnosis of SARS-CoV-2 and serum samples were sent for analysis of IL-6, CRP, d-Dimers and fibrinogen. Results Compared with the control group, the subjects of the COVID-19 group were older (59±19.5 vs.38±19.15 years, p=0.0002) and had more underlying comorbidities such as hypertension (60% vs 35%, p=0.06) or were overweight (53.3% vs 30%, p=0.08). The levels of CRP, IL-6, fibrinogen and d-Dimers in postmortem plasma samples were significantly higher in COVID-19 subjects than in control group (p< 0.0001). Moreover, the level of IL-6 was significantly higher in overweight patients (r=0.52, P<0.001). In all COVID-19 subjects, the histological examination revealed features corresponding to the exudative and/or proliferative phases of diffuse alveolar damage. Large pulmonary emboli were observed in 7 cases. Gross cardiac enlargement with left ventricular hypertrophy was observed in 19 cases. The most frequent pathological finding of the central nervous system was acute/early-subacute infarction. Conclusion Due to the complexity of the inflammatory response, we postulate that a combination of biomarkers, rather than a single laboratory parameter, might be more effective in obtaining a reliable postmortem COVID-19 diagnosis.
Collapse
Affiliation(s)
- Talida Georgiana Cut
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Timisoara, Timisoara, Romania,Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Academy of Romanian Scientists, Bucharest, Romania
| | - Veronica Ciocan
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Department of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Correspondence: Veronica Ciocan, Department of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania, Tel +40722944453, Email
| | - Dorin Novacescu
- Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Academy of Romanian Scientists, Bucharest, Romania
| | - Adrian Voicu
- Department of Medical Informatics and Biostatistics, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adelina Raluca Marinescu
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Timisoara, Timisoara, Romania
| | - Voichita Elena Lazureanu
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Timisoara, Timisoara, Romania
| | - Camelia Oana Muresan
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Department of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alexandra Enache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Department of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Raluca Dumache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania,Department of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| |
Collapse
|
8
|
AlGhamdi Z, Alqahtani SY, AlDajani K, Alsaedi A, Al-Rubaish O, Alharbi A, Elbawab H. Pneumothorax in Critically Ill COVID-19 Patients: Prevalence, Analysis of Risk Factors and Clinical Outcomes. Int J Gen Med 2022; 15:8249-8256. [PMID: 36438021 PMCID: PMC9698325 DOI: 10.2147/ijgm.s387868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Previous studies have been conducted to assess pneumothorax. However, few studies were done to assess pneumothorax in COVID-19 patients in the intensive care unit (ICU). OBJECTIVE Our aim is to describe and analyze the prevalence, clinical characteristics, risk factors, and outcomes of COVID-19 pneumothorax patients in the intensive care unit. METHODS We performed a retrospective review of the medical records of 418 patients, who tested positive for COVID-19 by polymerase chain reaction test and required ICU admission in King Fahad Hospital of The University from 02/01/2020 to 01/09/2021. A total number of 36 pneumothorax patients were included in the study. RESULTS Of 418 patients who were followed up in the intensive care unit as COVID-19 cases, 36 patients developed a pneumothorax (8.61%). The mean age of the patients was 55.6 ± 15.06 years, 23 patients were male, and 13 were female. Seventeen patients were obese, and only one patient was an active smoker. Twenty-four patients had at least one comorbidity; hypertension was the most common. Thirty-two patients were intubated, and the duration of intubation was 23.23 ±15.9 days. The time from intubation to pneumothorax development was 8.8 ± 9.3 days. Six patients were on bilevel positive airway pressure ventilation (BIPAP), 2 patients on continuous positive airway pressure ventilation (CPAP), 3 patients on High-Flow Nasal Cannula ventilation (HFNC), 9 patients on pressure-control ventilation (PC), and 16 patients on pressure regulated volume control ventilation (PRVC). Of 36 patients, 26 died, and the mortality rate was 72.2%. CONCLUSION Our study showed that risk factors of pneumothorax occurrence in COVID-19 critically ill patients include male patients, hypertension, diabetes mellitus, endotracheal intubation and mechanical ventilation. More efforts should be made to determine the risk factors and assess the outcomes of those patients to develop preventive measures and management guidelines.
Collapse
Affiliation(s)
- Zeead AlGhamdi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaya Y Alqahtani
- Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid AlDajani
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ammar Alsaedi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omar Al-Rubaish
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulmajeed Alharbi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem Elbawab
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
9
|
Muacevic A, Adler JR. Pneumomediastinum and Pneumopericardium as Uncommon Complications of COVID-19 Infection: A Review Article. Cureus 2022; 14:e30244. [PMID: 36381752 PMCID: PMC9650929 DOI: 10.7759/cureus.30244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/03/2022] Open
Abstract
There is an emerging body of literature describing an increasing incidence of pneumomediastinum and, to a lesser extent, pneumopericardium as a complication of COVID-19. However, the literature lacks information regarding patients' characteristics and a general view of this unusual condition. The purpose of this paper is to summarize the current literature on this phenomenon. In this study, we summarize the risk factors/etiology, imaging modalities, management, and prognosis of known cases in the literature. In total, 48 articles were included in the study, ranging from case reports to case series. Most patients were male (83.3%). The overall mortality rate was 27.1% and the recovery rate was 62.5%.
Collapse
|
10
|
DİREK T, İNAN K, ŞENGÜL İNAN M, ŞAHİN MF, AYTEKİN ÇELİK İ, KARAOGLANOGLU N. Analysis of the factors that affect survival among patients who developed subcutaneous emphysema monitored on COVID-19 diagnosis: single-centred research. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1146541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The COVID-19 patients with pulmonary involvement frequently develop pneumothorax, pneumomediastinum and subcutaneous emphysema due to barotrauma. Reviewing the literature, pneumothorax, pneumomediastinum and subcutaneous emphysema it can be observed among ICU patients due to the pulmonary involvement of the COVID-19 disease, and therefore, can cause mortality and morbidity. This study aims to analyse the factors that affect mortality in COVID-19 patients in ICUs who develop subcutaneous emphysema.
Material and Method: A total of 854 COVID-19 patients who were consulted from all branches in the Chest Surgery Clinic of Ankara City Hospital between September 1, 2020 - March 1, 2021 were retrospectively analyzed. Demographic characteristics, comorbid diseases and COVID-related tests (LDH, D-dimer, procalcitonin, ferritin, CRP, IL-6, lymphocyte percentage and neutrophil and lymphocyte ratio) imaging results and survival of 66 patients with subcutaneous emphysema were analyzed.
Results: Of the patients, 41 (62%) were male and 25 (38%) were female. The mean age was 63 years. 55 (83%) of these patients were followed up with invasive ventilation support due to general health impairment, increased oxygen demand and heart problems. Age, intubation and NLR were found to be statistically significant in terms of survival and death, on survival. It was discovered that age and intubation variables could be risk factors. The mortality rates were 1.01 times higher for the elderly compared to the younger patients and 13.8 times higher for the intubated compared to the non-intubated patients.
Conclusion: Age of patient and intubation can be regarded as risk factors for mortality in COVID-19 patients with subcutaneous emphysema, monitored in ICUs. Furthermore, comorbid diseases increase mortality rates.
Collapse
|
11
|
Guerra FS, Piccarreta R, Carpentiere R, Panunzio A, Guglielmi G. Pneumomediastinum: a rare complication in COVID-19 patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022270. [PMID: 36134719 PMCID: PMC10510955 DOI: 10.23750/abm.v93is1.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
A 62-year-old man with COVID-19 had PS for fever, coughing, and breathlessness. Two days after therapy, the patient's clinical condition worsened. X-ray and CT showed pneumomediastinum, emphysema and pneumothorax. The patient was intubated and subjected to conservative therapy. The patient was discharged after about 20 days. Radiological imaging plays a key role in the proper diagnosis and treatment of COVID-19 patients with related complications.
Collapse
|
12
|
Pierre L, Rieu J, Lemmet T, Ion C, Gravier S, Mohseni-Zadeh M, Lawson T, Gerber V, Martinot M. Characteristic outcomes and risk assessment of pneumothorax in 21 patients with COVID-19. Infect Dis Now 2022; 52:321-323. [PMID: 35537685 PMCID: PMC9077797 DOI: 10.1016/j.idnow.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Affiliation(s)
- L Pierre
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - J Rieu
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - T Lemmet
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - C Ion
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - S Gravier
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - M Mohseni-Zadeh
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - T Lawson
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France; UFR of Health Sciences, University of Thiès, Thiès, Senegal
| | - V Gerber
- Intensive Care Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M Martinot
- Infectious Diseases Department Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France.
| |
Collapse
|
13
|
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.
Collapse
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..
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in non-ventilated COVID-19 patients. Future Sci OA 2022; 8:FSO771. [PMID: 35059221 PMCID: PMC8609960 DOI: 10.2144/fsoa-2021-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/02/2021] [Indexed: 01/08/2023] Open
Abstract
Aim: Pneumothorax (PNX), pneumomediastinum (PMD) and subcutaneous emphysema (SCE) are COVID-19 complications related to positive-pressure ventilation. We analyzed the pathophysiology of these complications without ventilation. Patients & methods: Out of 1845 admitted COVID-19 patients, we retrospectively collected data for 15 patients, from a tertiary medical center, from 1 October 2020 to 31 March 2021. Results: Five patients suffered from spontaneous PNX, 8/15 developed PMD and 8/15 developed SCE. The mean BMI was 29.7, as most patients were obese or overweight. Most patients had lymphocytopenia and increased C-reactive protein, ferritin and lactate dehydrogenase levels. Eleven patients succumbed to the disease. Conclusion: Risk factors of spontaneous PNX, PMD and SCE in COVID-19 patients need further investigations by conducting more comprehensive case–control studies. We have investigated spontaneous alveolar rupture as a complication in 15 COVID-19 patients. Manifested as pneumothorax, pneumomediastinum and subcutaneous emphysema, these complications are less common in patients without mechanical ventilation. Management of these patients was either conservative or by insertion of a chest tube. Eventually, 11 out of 15 patients have passed away due to respiratory failure.
Collapse
|
16
|
Laza R, Lazureanu VE, Musta VF, Nicolescu ND, Vernic C, Tudor A, Critu R, Vilceanu L, Paczeyka R, Bica Profir V, Marinescu AR, Mocanu A, Cut TG, Lighezan DF, Baditoiu LM. COVID-19 Independent Risk Factors for Unfavorable Disease Progression: A Cross-Sectional Study from Romania. Int J Gen Med 2022. [DOI: 10.2147/ijgm.s350920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
17
|
Marza AM, Petrica A, Lungeanu D, Sutoi D, Mocanu A, Petrache I, Mederle OA. Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection. Int J Gen Med 2022; 15:489-500. [PMID: 35046709 PMCID: PMC8760984 DOI: 10.2147/ijgm.s347178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Spontaneous pneumothorax (SP) and spontaneous pneumomediastinum (SPM) have frequently been cited as complications associated with coronavirus disease 2019 (COVID-19) pneumonia, with especially poor prognosis in mechanically ventilated patients. The current literature is controversial regarding the potential risk factors for developing SP or SPM (SP-SPM) in non-ventilated COVID-19 patients. Our research addressed a twofold objective: (a) to investigate the characteristics of patients with SP-SPM (both with and without COVID-19) and compare them to patients with sole COVID-19; (b) to quantify the risk of in-hospital mortality associated with SP-SPM and COVID-19. Patients and Methods A retrospective case–control study was conducted in the emergency departments (ED) of two tertiary hospitals in Timisoara, Romania, over one year (1st April 2020‒31st March 2021; 64,845 records in total) and 70 cases of SP-SPM were identified (both SARS-CoV-2 positives and negatives). The control group comprised COVID-19 patients with no SP-SPM, included at a 2:1 ratio. Logistic regression was employed to quantify the in-hospital mortality risk associated with age, SP-SPM, and COVID-19. Results SP-SPM and COVID-19 were connected with prolonged hospitalization, a higher percentage of intensive care admission, and a higher mortality. SP-SPM increased the odds of death by almost four times in patients of the same age, gender, smoking status, and SARS-CoV-2 infection: OR = 3.758, 95% CI (1.443–9.792). Each additional year of age added 9.4% to the mortality risk: OR = 1.094, 95% CI (1.054–1.135). Conclusion ED physicians should acknowledge these potential risks when attending COVID-19 patients with SP-SPM.
Collapse
Affiliation(s)
- Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
- Correspondence: Alina Petrica Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, RomaniaTel +40744772427 Email
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Diana Lungeanu Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, Romania Email
| | - Dumitru Sutoi
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Anaesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
| | - Alexandra Mocanu
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Ioan Petrache
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Thoracic Surgery, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| |
Collapse
|
18
|
Alsamman M, Dunn S, Busse S, Hamza A. Asymptomatic Spontaneous Pneumopericardium, Pneumomediastinum, and Subcutaneous Emphysema: A Case Report of an Incidental Rare Presentation. Cureus 2021; 13:e20464. [PMID: 35070528 PMCID: PMC8760893 DOI: 10.7759/cureus.20464] [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: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. They are normally self-limited unless tension pneumothorax, tension PM, cardiac herniation, air tamponade, and esophageal rupture accompany these disorders. PM and PP can be divided into "spontaneous" or "secondary" based on the preceding etiologies. Spontaneous PM is often extremely rare and benign in course. On the other hand, secondary PM and PP are more common and result from intrathoracic infections, trauma-related esophageal rupture, or tears along the tracheobronchial tree. Our patient presented four days after a fall from a chair and was found to have suffered a stroke, with complete left side paralysis. CT imaging on arrival was significant for PM, PP, and SE, the cause of which remains unclear. The patient was diagnosed with COVID-pneumonia approximately six months prior to presentation. As the COVID-19 pandemic has evolved, several scientific papers have been published reporting infected patients who had developed spontaneous PT, PM, or even PP, in the absence of invasive mechanical ventilation. Is it possible that the spontaneous findings in our patient were COVID-related? Or could the spontaneous PP, PM, and SE be a sequel to the trauma of her fall from a chair? The answer still remains unclear.
Collapse
Affiliation(s)
- Mrhaf Alsamman
- Internal Medicine, Health Corporation of America-University of Central Florida (HCA-UCF) Consortium, Ocala, USA
| | - Sandi Dunn
- Internal Medicine, Health Corporation of America-University of Central Florida (HCA-UCF) Consortium, Ocala, USA
| | - Shaye Busse
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Alan Hamza
- Internal Medicine, Ocala Regional Medical Center (ORMC), Ocala, USA
| |
Collapse
|
19
|
Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania. ACTA ACUST UNITED AC 2021; 57:medicina57101099. [PMID: 34684136 PMCID: PMC8539017 DOI: 10.3390/medicina57101099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of "Victor Babes" Hospital, Timis County, in order to assess the incidence, outcome and risk factors for clostridium difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.
Collapse
|
20
|
Cutaneous Manifestations in SARS-CoV-2 Infection-A Series of Cases from the Largest Infectious Diseases Hospital in Western Romania. Healthcare (Basel) 2021; 9:healthcare9070800. [PMID: 34202233 PMCID: PMC8304390 DOI: 10.3390/healthcare9070800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with a predominantly respiratory-oriented aggression. Although this lung damage, responsible for the more than 3,090,025 deaths, has provided sufficient data to facilitate the understanding of pathogenic mechanisms, other observation data, which meet the quality of emerging clinical aspects, such as rashes, remain without well-defined etiopathogenic support or a well-contoured clinical framework. (2) Methods and Results: We followed the occurrence of cutaneous manifestations in patients hospitalized during the second and third outbreak of SARS-CoV-2 in the main clinics of infectious diseases of our county, Timis, and recorded laboratory investigations and clinical evolution for five suggestive cases. (3) Conclusions: The presented cases, added to many other present and future clinical observations, will allow for better knowledge and understanding of SARS-CoV-2 infection, a requirement that has become a global priority for the entire medical and scientific community.
Collapse
|
21
|
Kalpaxi A, Kalokairinou M, Katseli P, Savvopoulou V, Ioannidi P, Triantafyllou E, Flokatoula M, Pythara C, Papaevangelou A. Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging. Radiol Case Rep 2021; 16:2586-2592. [PMID: 34178187 PMCID: PMC8220909 DOI: 10.1016/j.radcr.2021.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Spontaneous pneumomediastinum is a rare complication of coronavirus disease 2019. The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital, 3 coronavirus disease 2019 patients developed spontaneous pneumomediastinum: 1 on admission at the emergency department and the other 2 during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.
Collapse
Affiliation(s)
- Angeliki Kalpaxi
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Mariana Kalokairinou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Paraskevi Katseli
- Department of Internal Medicine, Thriassio General Hospital of Elefsina, Magoula, Athens, Greece
| | - Vasiliki Savvopoulou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Pinelopi Ioannidi
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Evangelia Triantafyllou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Maria Flokatoula
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Chrystalla Pythara
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Angeliki Papaevangelou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| |
Collapse
|