Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
Clin Med (Lond) ; 22(3): 271-275, 2022 05.
Article in English | MEDLINE | ID: covidwho-1856276

ABSTRACT

Pneumomediastinum and pneumothorax are recognised complications encountered in COVID-19 before or during invasive mechanical ventilation (IMV). The clinical course of patients developing pneumomediastinum before IMV is yet to be evaluated.Four-thousand, one-hundred and thirty-one patients hospitalised with COVID-19 over a 12-month period were retrospectively reviewed to evaluate for incidence, clinical characteristics and outcomes. A subgroup analysis was done to identify any clinical traits between survivors and non-survivors. The overall incidence of pneumomediastinum prior to IMV was 0.92% (n=38) and was seen at admission or during non-invasive respiratory support. Thirty-seven per cent had associated pneumothorax most commonly unilateral (right side). The median (interquartile range (IQR)) duration from admission to developing pneumomediastinum was 7 days (3-11) and complete resolution was seen in 53% of patients; median (IQR) duration to resolution was 8 days (4-17). The in-hospital mortality associated with pneumomediastinum in patients with SARS-CoV-2 (PneumoCoV) was 55%. Increasing age (68 ± 12 years vs 56 ± 14 years; p=0.01), higher body mass index (31 ± 5 kg/m2 vs 28 ± 5 kg/m2; p=0.04), lack of resolution of pneumomediastinum (67% vs 24%; p=0.01; odds ratio (OR) 6.5; 95% confidence interval (CI) 1.5-27.5), presence of concurrent pneumothorax (65% vs 14%; p=0.002; OR 11; 95% CI 2.2-53.1) and elevated procalcitonin levels (>0.5 ng/mL; 81% vs 41%; p=0.01; OR 6; 95% CI 1.4-26) were significant features in those who did not survive.The incidence of PneumoCoV, despite being low, is associated with increased mortality. It is a hallmark of moderate to severe disease with multifaceted contributory factors. Both demographic and clinical factors predict survival.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Humans , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , SARS-CoV-2
2.
Respir Med ; 197: 106853, 2022 06.
Article in English | MEDLINE | ID: covidwho-1796148

ABSTRACT

PURPOSE: To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients. MATERIALS AND METHODS: This is an observational, case-control study. Consecutive COVID-19 patients who underwent chest CT scan at hospital admission during the study time period (October 1st, 2020-April 31st, 2021) were identified. Macklin effect accuracy for prediction of spontaneous barotrauma was measured in terms of sensitivity, specificity, positive (PPV) and negative predictive values (NPV). RESULTS: Overall, 981 COVID-19 patients underwent chest CT scan at hospital arrival during the study time period; 698 patients had radiological signs of interstitial pneumonia and were considered for further evaluation. Among these, Macklin effect was found in 33 (4.7%), including all 32 patients who suffered from barotrauma lately during hospital stay (true positive rate: 96.9%); only 1/33 with Macklin effect did not develop barotrauma (false positive rate: 3.1%). No barotrauma event was recorded in patients without Macklin effect on baseline chest CT scan. Macklin effect yielded a sensitivity of 100% (95% CI: 89.1-100), a specificity of 99.85% (95% CI: 99.2-100), a PPV of 96.7% (95% CI: 80.8-99.5), a NPV of 100% and an accuracy of 99.8% (95% CI: 99.2-100) in predicting PMD/PNX, with a mean advance of 3.2 ± 2.5 days. Moreover, all Macklin-positive patients developed ARDS requiring ICU admission and, in 90.1% of cases, invasive mechanical ventilation. CONCLUSIONS: Macklin effect has high accuracy in predicting PMD/PNX in COVID-19 patients; it is also an excellent predictor of disease severity.


Subject(s)
Barotrauma , COVID-19 , Mediastinal Emphysema , Pneumothorax , Barotrauma/complications , Barotrauma/diagnostic imaging , COVID-19/complications , COVID-19/diagnostic imaging , Case-Control Studies , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pneumothorax/epidemiology , Tomography, X-Ray Computed
3.
J Nepal Health Res Counc ; 19(3): 460-466, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1687865

ABSTRACT

BACKGROUND: Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms.. METHODS: A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings. RESULTS: The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventilation. All intubated patients were on lung protective mechanical ventilation. The median PEEP, peak airway pressure and plateau pressure were 10 (IQR: 4), 29 (IQR: 8) and 28 (IQR: 4) respectively. The mean CT severity score was 22.7 (SD: 1.64). Five patients died after 6.8 days (SD: 4.8) of diagnosis. The average hospital stay was of 34 days. CONCLUSIONS: Pneumomediastinum is a possible complication of COVID-Acute respiratory distress syndrome which could signify the disease severity and vice versa. Furthermore, it could be an indicator of relatively poor prognosis and therefore requires larger studies to establish the association.


Subject(s)
COVID-19 , Mediastinal Emphysema , Respiratory Distress Syndrome , Cross-Sectional Studies , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Nepal/epidemiology , Respiration, Artificial , Respiratory Distress Syndrome/epidemiology , SARS-CoV-2
4.
Drug Discov Ther ; 15(6): 310-316, 2021.
Article in English | MEDLINE | ID: covidwho-1622789

ABSTRACT

COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Tertiary Healthcare
5.
Clin Med (Lond) ; 21(6): e615-e619, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1551858

ABSTRACT

BACKGROUND: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. METHODS: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. RESULTS: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001). CONCLUSIONS: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Humans , Intensive Care Units , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2
7.
Interact Cardiovasc Thorac Surg ; 34(2): 236-244, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1447595

ABSTRACT

OBJECTIVES: The incidence of pneumomediastinum (PNMD), its causes of development and its effect on prognosis in the coronavirus disease 2019 (COVID-19) are not clear. METHODS: Between March 2020 and December 2020, 427 patients with real-time reverse transcriptase-polymerase chain reaction-confirmed COVID-19 admitted to the intensive care unit were analysed retrospectively. Using receiver operating characteristic analysis, the area under the curve (AUC) for initial invasive mechanical ventilation (MV) variables such as initial peak inspiratory pressure (PIP), PaO2/FiO2 (P/F ratio), tidal volume, compliance and positive end-expiratory pressure was evaluated regarding PNMD development. RESULTS: The incidence of PNMD was 5.6% (n = 24). PNMD development rate was 2.7% in non-invasive MV and 6.2% in MV [odds ratio (OR) 2.352, 95% confidence interval (CI) 0.541-10.232; P = 0.400]. In the multivariate analysis, the independent risk factors affecting the development of PNMD were PIP (OR 1.238, 95% CI 1.091-1.378; P < 0.001) and P/F ratio (OR 0.982, 95% CI 0.971-0.994; P = 0.004). P/F ratio (AUC 0.815, 95% CI 0.771-0.854), PIP (AUC 0.780, 95% CI 0.734-0.822), compliance (AUC 0.735, 95% CI 0.677-0.774) and positive end-expiratory pressure (AUC 0.718, 95% CI 0.668-0.764) were the best predictors for PNMD development. Regarding the multivariate analysis, independent risk factors affecting mortality were detected as age (OR 1.015, 95% CI 0.999-1.031; P = 0.04), comorbidity (OR 1.940, 95% CI 1.100-3.419; P = 0.02), mode of breathing (OR 48.345, 95% CI 14.666-159.360; P < 0.001), PNMD (OR 5.234, 95% CI 1.379-19.857; P = 0.01), positive end-expiratory pressure (OR 1.305, 95% CI 1.062-1.603; P = 0.01) and tidal volume (OR 0.995, 95% CI 0.992-0.998; P = 0.004). CONCLUSIONS: PNMD development was associated with the initial P/F ratio and PIP. Therefore, it was considered to be related to both the patient and barotrauma. PNMD is a poor prognostic factor for COVID-19.


Subject(s)
COVID-19 , Mediastinal Emphysema , Humans , Incidence , Intensive Care Units , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , SARS-CoV-2
8.
J Intensive Care Med ; 37(1): 12-20, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1405276

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.


Subject(s)
COVID-19 , Mediastinal Emphysema , Case-Control Studies , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2
9.
Epidemiol Infect ; 149: e137, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1260912

ABSTRACT

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.


Subject(s)
COVID-19/complications , Hemothorax/etiology , Mediastinal Emphysema/etiology , Pneumothorax/etiology , Respiratory Distress Syndrome/complications , Subcutaneous Emphysema/etiology , Adult , Aged , Barotrauma/epidemiology , Barotrauma/etiology , COVID-19/epidemiology , COVID-19/therapy , Female , Hemothorax/epidemiology , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Lung Injury/epidemiology , Lung Injury/etiology , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/epidemiology , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Subcutaneous Emphysema/epidemiology
10.
Respir Investig ; 59(5): 661-665, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1253540

ABSTRACT

In this study, we compared the incidence of pneumomediastinum in coronavirus disease (COVID-19) patients during the ascending phases of the 1st and 2nd epidemic waves. Crude incidence was higher during the 2nd wave at a quasi-significant level (0.68/1000 vs. 2.05/1000 patient-days, p = 0.05). When restricting the analysis to patients who developed pneumomediastinum during noninvasive ventilation, the difference became clearly significant (0.17/1000 vs 1.36/1000 patient-days, p = 0.039). At logistic regression, predisposing factors (p = 0.031), and COVID-19 radiological severity (p = 0.019) were independently associated with pneumomediastinum. Mortality in patients with pneumomediastinum was 87.5%. However, pneumomediastinum seemed to be related to a generally worse disease presentation in hospitalized patients during the 2nd wave, rather than to a separate pattern of disease.


Subject(s)
COVID-19 , Mediastinal Emphysema , COVID-19/complications , Humans , Incidence , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pneumothorax , SARS-CoV-2
11.
Khirurgiia (Mosk) ; (5): 20-24, 2021.
Article in Russian | MEDLINE | ID: covidwho-1225976

ABSTRACT

OBJECTIVE: To determine the optimal management of pneumomediastinum in patients with a novel coronavirus infection (COVID-19). MATERIAL AND METHODS: There were 14 patients with pneumomediastinum and COVID-19 infection without mechanical ventilation. We discussed the world data on pneumomediastinum in patients with coronavirus infection. RESULTS: Before the COVID-19 pandemic, the annual number of own observations of spontaneous pneumomediastinum did not exceed 1-2 patients. The mechanism of pneumomediastinum is explained by the Macklin effect. COVID-19 pandemic in the Russian Federation was followed by increase of the number of patients with pneumomediastinum up to 2.4% of the total number of patients in the thoracic department. In this sample, pneumomediastinum occurred at all variants of the course of coronavirus infection. The timing of pneumomediastinum ranged from 2 to 18 (median 14) days after clinical manifestation of COVID-19. In 2 out of 14 cases, pneumomediastinum was the main symptom of coronavirus infection at admission. One patient had a combination of pneumomediastinum and pneumothorax. In 6 cases, pneumomediastinum was stable and regressed under conservative therapy. Eight patients underwent Razumovsky suprajugular mediastinotomy. There were no postoperative deaths. Recurrent pneumomediastinum was noted in one patient. CONCLUSION: The causes of pneumomediastinum in some patients with coronavirus infection, peculiarities of diagnosis and treatment and clarification of indications for invasive interventions require further study.


Subject(s)
COVID-19 , Mediastinal Emphysema , Humans , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pandemics , Russia/epidemiology , SARS-CoV-2
12.
Asian Cardiovasc Thorac Ann ; 29(6): 541-548, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1186500

ABSTRACT

AIM: Pneumomediastinum (PM) is associated with several etiologies and mechanisms. Although it has been described more than 100 years ago, the literature is limited to small retrospective studies. This study aimed to follow patients with coronavirus disease (COVID-19) that developed PM during hospitalization and describe their clinical and radiological evolution. METHODS: A prospective cohort was developed with patients with PM, excluding those with aerodigestive trauma, inside a hospital COVID-19 dedicated hospital. Clinical variables including onset of symptoms, hemodynamic instability, associated complications, the need of interventions, and disease course were all recorded. Also, radiological findings such as the presence of the Macklin effect, extension of lung involvement by COVID-19, and characteristics of the PM were analyzed. RESULTS: Twenty-one patients with non-traumatic PM were followed, resulting in an overall incidence of 0.5% during the study period. Seven (33%) patients had associated pneumothorax and malignant/tension PM was observed in three (14%) cases. The Macklin effect could be found in 11 patients (52%) and the majority of them had more than 50% of lung involvement due to COVID-19. The mortality rate was 49%; however, no deaths were directly related to the PM. CONCLUSIONS: PM incidence is probably increased in the severe acute respiratory syndrome caused by COVID-19, especially in those with greater involvement of the lungs, and the Macklin effect may be an important underlying mechanism of this complication. Usually, PM has a benign course, but complications like tension/malignant PM may occur requiring prompt detection and intervention.


Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Mediastinal Emphysema/physiopathology , Adult , Aged , Female , Humans , Incidence , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Middle Aged , Prospective Studies , Tomography, X-Ray Computed
14.
Epidemiol Infect ; 149: e37, 2021 01 20.
Article in English | MEDLINE | ID: covidwho-1072077

ABSTRACT

Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Mediastinal Emphysema/etiology , SARS-CoV-2 , Subcutaneous Emphysema/etiology , Adult , Aged , Female , Humans , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pakistan/epidemiology , Subcutaneous Emphysema/epidemiology , Tertiary Care Centers , Young Adult
15.
J Cardiothorac Vasc Anesth ; 35(12): 3642-3651, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1065998

ABSTRACT

OBJECTIVE: To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN: Observational study. SETTING: Tertiary-care university hospital. PARTICIPANTS: One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. INTERVENTIONS: The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. MEASUREMENTS AND MAIN RESULTS: PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). CONCLUSION: PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial/adverse effects , SARS-CoV-2
16.
Monaldi Arch Chest Dis ; 90(4)2020 Sep 29.
Article in English | MEDLINE | ID: covidwho-1060301

ABSTRACT

Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/therapy , Female , Humans , Incidence , Italy , Male , Mediastinal Emphysema/therapy , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
17.
J Laparoendosc Adv Surg Tech A ; 31(3): 273-278, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-772741

ABSTRACT

Introduction: Pneumomediastinum (PM) is characterized by the presence of air within the mediastinum. The association between PM and coronavirus 2019 (COVID-19) has not been well established in the current literature. We sought to summarize the limited body of literature regarding PM in patients with COVID-19 and characterize the presentation and clinical outcomes of PM in patients with severe acute respiratory syndrome (SARS)-COV-2 pneumonia at our institution to better define the incidence, prognosis, and available treatment for this condition. Materials and Methods: All patients with a proven diagnosis of COVID-19 and PM between March 18, 2020 and May 5, 2020 were identified through hospital records. Retrospective analysis of radiology records and chart review were conducted. Clinical characteristics and outcomes were collected and descriptive statistics was analyzed. Results: Thirty-six patients met inclusion criteria. Out of the 346 intubated COVID-19 patients, 34 (10%) had PM. The incidence of PM increased for the first 4 weeks of the pandemic, and then began to decrease by week 5. At the endpoint of the study, 12 (33.33%) patients were alive and 24 patients (66.67%) had died. Conclusion: PM, although a rare phenomenon, was more prevalent in COVID-19 patients compared with historical patients with adult respiratory distress syndrome. The etiology of this condition may be attributed to higher susceptibility of patients infected with SARS-CoV-2 to a combination of barotrauma and airway injury.


Subject(s)
COVID-19/epidemiology , Mediastinal Emphysema/diagnosis , Pandemics , SARS-CoV-2 , Aged , COVID-19/complications , COVID-19/diagnosis , Female , Humans , Male , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Middle Aged , Prognosis , Retrospective Studies
18.
Clin Imaging ; 67: 207-213, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-733899

ABSTRACT

PURPOSE: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. MATERIALS AND METHODS: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. RESULTS: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. CONCLUSION: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.


Subject(s)
Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Subcutaneous Emphysema/etiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Comorbidity , Coronavirus Infections/virology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pandemics , Pneumonia, Viral/virology , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial/adverse effects , SARS-CoV-2 , Subcutaneous Emphysema/epidemiology , Tomography, X-Ray Computed/methods
SELECTION OF CITATIONS
SEARCH DETAIL