ABSTRACT
BACKGROUND: A high incidence of air leak syndromes (ALS) has been reported in critically ill COVID-19 patients. This not only prolongs the hospital stay of patients but also affects the disease outcome. OBJECTIVE: Our objective is to evaluate the incidence, clinical outcome, and risk factors associated with ALS in critically ill COVID-19 patients receiving invasive or non-invasive positive pressure ventilation RESULT: Out of 79 patients, 16(20.2%) patients had ALS. The mean age of the ALS group was 48.6±13.1 years as compared to 52.8±13.1 (p = 0.260) years in the non-ALS group. The ALS group had a lower median BMI (25.9 kg/m2 vs 27.6 kg/m2 , p = 0.096), a higher D-dimer value at presentation (1179.5 vs 762.0, p = 0.024) , lower saturation (74% vs 88%, p = 0.006) and lower PF (134 vs 189, p = 0.028) ratio at presentation as compared to the ALS group. Patients who developed ALS were found to have received a higher median PEEP (10 cm vs 8 cm of water, p = 0.005). Pressure support, highest driving pressure, and peak airway pressure were not significantly different in the two groups. ALS group was seen to have a significantly longer duration of hospital stay (17.5 days vs 9 days, p = 0.003). Multiple Logistic Regressions analysis indicated patients who received Inj. Dexamethasone was less likely to develop ALS (OR: 12.6 (95% CI 1.6-95.4), p=0.015). CONCLUSION: A high incidence of ALS is present in critically ill COVID 19 patients. High inflammatory parameters, severe hypoxia at presentation, and use of high PEEP are significant risk factors associated with the development of ALS. The risk of developing ALS was observed to be lower in patients who received Inj. Dexamethasone. ALS is associated with a longer duration of hospital stay.