Pneumomediastinum and subcutaneous emphysema in COVID-19 : barotrauma or lung frailty?
Copyright ©ERS 2020..
BACKGROUND: In mechanically ventilated acute respiratory distress syndrome (ARDS) patients infected with the novel coronavirus disease (COVID-19), we frequently recognised the development of pneumomediastinum and/or subcutaneous emphysema despite employing a protective mechanical ventilation strategy. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in COVID-19 patients was higher than in ARDS patients without COVID-19 and if this difference could be attributed to barotrauma or to lung frailty.
METHODS: We identified both a cohort of patients with ARDS and COVID-19 (CoV-ARDS), and a cohort of patients with ARDS from other causes (noCoV-ARDS).Patients with CoV-ARDS were admitted to an intensive care unit (ICU) during the COVID-19 pandemic and had microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period.
RESULTS: Pneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in three out of 163 (1.9%) patients with noCoV-ARDS (p<0.001). Mortality was 56.5% in CoV-ARDS patients with pneumomediastinum/subcutaneous emphysema and 50% in patients without pneumomediastinum (p=0.46).CoV-ARDS patients had a high incidence of pneumomediastinum/subcutaneous emphysema despite the use of low tidal volume (5.9±0.8 mL·kg-1 ideal body weight) and low airway pressure (plateau pressure 23±4 cmH2O).
CONCLUSIONS: We observed a seven-fold increase in pneumomediastinum/subcutaneous emphysema in CoV-ARDS. An increased lung frailty in CoV-ARDS could explain this finding more than barotrauma, which, according to its etymology, refers to high transpulmonary pressure.
| Errataetall: |
CommentIn: Respiration. 2021;100(12):1251-1255. - PMID 34515225 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:6 |
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| Enthalten in: |
ERJ open research - 6(2020), 4 vom: 30. Okt. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lemmers, Daniel H L [VerfasserIn] |
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| Anmerkungen: |
Date Revised 18.04.2022 published: Electronic-eCollection CommentIn: Respiration. 2021;100(12):1251-1255. - PMID 34515225 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1183/23120541.00385-2020 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318242591 |
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| 500 | |a CommentIn: Respiration. 2021;100(12):1251-1255. - PMID 34515225 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright ©ERS 2020. | ||
| 520 | |a BACKGROUND: In mechanically ventilated acute respiratory distress syndrome (ARDS) patients infected with the novel coronavirus disease (COVID-19), we frequently recognised the development of pneumomediastinum and/or subcutaneous emphysema despite employing a protective mechanical ventilation strategy. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in COVID-19 patients was higher than in ARDS patients without COVID-19 and if this difference could be attributed to barotrauma or to lung frailty | ||
| 520 | |a METHODS: We identified both a cohort of patients with ARDS and COVID-19 (CoV-ARDS), and a cohort of patients with ARDS from other causes (noCoV-ARDS).Patients with CoV-ARDS were admitted to an intensive care unit (ICU) during the COVID-19 pandemic and had microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period | ||
| 520 | |a RESULTS: Pneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in three out of 163 (1.9%) patients with noCoV-ARDS (p<0.001). Mortality was 56.5% in CoV-ARDS patients with pneumomediastinum/subcutaneous emphysema and 50% in patients without pneumomediastinum (p=0.46).CoV-ARDS patients had a high incidence of pneumomediastinum/subcutaneous emphysema despite the use of low tidal volume (5.9±0.8 mL·kg-1 ideal body weight) and low airway pressure (plateau pressure 23±4 cmH2O) | ||
| 520 | |a CONCLUSIONS: We observed a seven-fold increase in pneumomediastinum/subcutaneous emphysema in CoV-ARDS. An increased lung frailty in CoV-ARDS could explain this finding more than barotrauma, which, according to its etymology, refers to high transpulmonary pressure | ||
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| 700 | 1 | |a Prezioso, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Cavallo, Erika |e verfasserin |4 aut | |
| 700 | 1 | |a Nencini, Niccolò |e verfasserin |4 aut | |
| 700 | 1 | |a Crisci, Serena |e verfasserin |4 aut | |
| 700 | 1 | |a Fusina, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a Natalini, Giuseppe |e verfasserin |4 aut | |
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