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Lorente-González M, Terán-Tinedo JR, Zevallos-Villegas A, Laorden D, Mariscal-Aguilar P, Suárez-Ortiz M, Cano-Sanz E, Ortega-Fraile MÁ, Hernández-Núñez J, Falcone A, Saiz-Lou EM, Plaza-Moreno MC, García-Fadul C, Valle-Falcones M, Sánchez-Azofra A, Funes-Moreno C, De-La-Calle-Gil I, Navarro-Casado R, Carballo-López D, Gholamian-Ovejero S, Gallego-Rodríguez B, Villén-Villegas T, Landete P. Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit. J Intensive Care Med 2023; 38:1023-1041. [PMID: 37306158 PMCID: PMC10261956 DOI: 10.1177/08850666231180165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. METHODS This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. RESULTS A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. CONCLUSIONS In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
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Affiliation(s)
- Miguel Lorente-González
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - José Rafael Terán-Tinedo
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Annette Zevallos-Villegas
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Laorden
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pablo Mariscal-Aguilar
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Miguel Suárez-Ortiz
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Eduardo Cano-Sanz
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Ángeles Ortega-Fraile
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Joaquín Hernández-Núñez
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Adalgisa Falcone
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Elena María Saiz-Lou
- Department of Internal Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Cristina Plaza-Moreno
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Christian García-Fadul
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Manuel Valle-Falcones
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Ana Sánchez-Azofra
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Clotilde Funes-Moreno
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Isabel De-La-Calle-Gil
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Rosalía Navarro-Casado
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Carballo-López
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Soraya Gholamian-Ovejero
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Berta Gallego-Rodríguez
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Tomás Villén-Villegas
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pedro Landete
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid [Autónoma University of Madrid], Madrid, Madrid, Spain
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Laorden D, Gholamian-Ovejero S, Terán-Tinedo JR, Lorente-González M, Cano-Sanz E, Ortega-Fraile MÁ, Alejos RM, Hernández-Nuñez J, De La Calle-Gil I, Navarro-Casado R, Neria F, Zevallos-Villegas A, Mariscal-Aguilar P, Suarez-Ortiz M, Plaza-Moreno MC, Carballo-López D, Gallego-Rodríguez B, Calderón-Alcala M, Latif-Essa A, Churruca-Arróspide M, Valle-Falcones M, Saiz-Lou EM, Rodríguez-Calle C, Funes-Moreno C, Villén-Villegas T, Landete P. Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit. Respir Care 2023; 68:67-76. [PMID: 36347563 PMCID: PMC9993511 DOI: 10.4187/respcare.10193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes. METHODS This was a retrospective, observational study performed at one hospital in Spain. We included consecutive subjects age > 18 y, admitted to IRCU with COVID-19 pneumonia, and requiring NRS between December 2020-September 2021. Data collected included mode and usage of NRS, laboratory findings, endotracheal intubation, and mortality at day 30. A multivariable Cox model was used to assess risk factors associated with clinical failure and mortality. RESULTS A total of 1,306 subjects were included; 64.6% were male with mean age of 54.7 y. During the IRCU stay, 345 subjects clinically failed NRS (85.5% intubated; 14.5% died). Cox model showed a higher clinical failure in IRCU upon onset of symptoms and hospitalization was < 10 d (hazard ratio [HR] 1.59 [95% CI 1.24-2.03], P < .001) and PaO2 /FIO2 < 100 mm Hg (HR 1.59 [95% CI 1.27-1.98], P < .001). These variables were not associated with increased 30-d mortality. CONCLUSIONS The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19.
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Affiliation(s)
- Daniel Laorden
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Soraya Gholamian-Ovejero
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Severo Ochoa University Hospital, Madrid, Spain
| | - José Rafael Terán-Tinedo
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain, and Pneumology Department, Gregorio Marañón University Hospital, Madrid, Spain; and Complutense University, School of Medicine, Madrid, Spain.
| | - Miguel Lorente-González
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, 12 Octubre University Hospital, Madrid, Spain
| | - Eduardo Cano-Sanz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - María Ángeles Ortega-Fraile
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Roberto-Martínez Alejos
- Philips France; and Respiratory Physiotherapy and Methodology Research Department, Montpellier University School of Physiotherapy, Montpellier, France
| | - Joaquín Hernández-Nuñez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Isabel De La Calle-Gil
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Rosalía Navarro-Casado
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Fernando Neria
- Francisco de Vitoria University, School of Medicine, Madrid, Spain
| | - Annette Zevallos-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, 12 Octubre University Hospital, Madrid, Spain
| | - Pablo Mariscal-Aguilar
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Miguel Suarez-Ortiz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - María Cristina Plaza-Moreno
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Daniel Carballo-López
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Berta Gallego-Rodríguez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Mariara Calderón-Alcala
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Aylaf Latif-Essa
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - María Churruca-Arróspide
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Manuel Valle-Falcones
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Elena María Saiz-Lou
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Internal Medicine Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Carmen Rodríguez-Calle
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Clotilde Funes-Moreno
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Tomas Villén-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Francisco de Vitoria University, School of Medicine, Madrid, Spain
| | - Pedro Landete
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, La Princesa University Hospital, Madrid, Spain; and Autónoma de Madrid University, School of Medicine, Madrid, Spain
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