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Introduction: During COVID-19 pandemic, the massive use of ventilatory support made its complications even more common. This study aimed to analyse the incidence of barotrauma in COVID-19 patients as well as its consequences. Method(s): Retrospective cohort study. All patients undergoing mechanical ventilation in an intensive care unit (ICU) during 2020- 2021 were included. The time of both noninvasive and invasive ventilation was considered together. Statistical analysis was performed using IBM SPSS Statistics 28.0. Result(s): A total of 967 patients were included, with 42 cases of barotrauma being reported (28 men and 14 women, median age 69 years [interval 22-94] and median APACHE 13). Out of those, 40 had severe COVID-19. Regarding patients with and without COVID-19, the incidence of barotrauma (episodes/1000 days of ventilation) was 0.64 and 9.22 (RR 14.86, p < 0.001) and the barotrauma rate (episodes/number of patients) was 0.4% and 8.5% (RR 21.25, p < 0.001), respectively. The most common type of barotrauma was subcutaneous emphysema (52.4%, CI 95% 37.3-67.5%), followed by pneumomediastinum (47.6%, CI 95% 32.5-62.7%) and pneumothorax (35.7%, IC 95% 21.2-50.2%). The median time to diagnosis was 11.5 days after initiation of ventilatory support [interval 1-67]. In the COVID-19 group, barotrauma was associated with longer ventilation (14.06 vs 7.91 days, p < 0.001), longer ICU stay (16.74 vs 8.17 days, p < 0.001) e higher mortality rates (45.0% vs 26.2%, RR 1.72, p 0.011). Conclusion(s): We found a higher susceptibility to developing barotrauma as a potential complication of COVID-19 patients undergoing mechanical ventilation. From those, subcutaneous emphysema and pneumomediastinum seem to be more prevalent than pneumothorax. Barotrauma seems to be associated with longer periods undergoing mechanical ventilation, longer ICU stays and higher hospital mortality rates.
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Introduction: Tracheostomy is a common surgical procedure in the setting of acute respiratory failure. And improves outcomes for critically patients requiring prolonged mechanical ventilation. Initially avoided due to it's high risk to biosafety, tracheostomy soon became a routine procedure in the critical support of critical ill patients affected by COVID-19. The aim of this review was to compare tracheostomy done in COVID-19 and non-COVID-19 pneumonias in an UCI. Method(s): This retrospective, observational study included 78 patients (23 female, 55 male;age range: 23-90 years, mean age: 66) with severe pneumonia who were admitted to the intensive care unit (ICU) of Hospital Beatriz Angelo (Portugal) between 01/03/2012 until 31/12/2021, to whom a tracheostomy was performed. Patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation, as well as complications, were reported and compared between patients with COVID-19 (N = 38) and non-COVID-19 (N = 40) pneumonias. Result(s): In both groups, weaning from difficult ventilation was the most common indication for the procedure, followed by prolonged mechanical ventilation in the COVID-19 group (42%) and protection of the airway/secretions management in the non-COVID-19 group (22.5%). Timing of the procedure was 14.6 and 16.4 days after mechanical ventilation in the COVID-19 and non-COVID group, respectively. The non-COVID-19 group reported more days to decannulation (39.3 vs 15.1 days) as well as more days to wean off from mechanical ventilation (20.3 vs 14.1 days) and more major complications (12.5% vs 2%). Hospital discharge rate was similar in both groups (COVID-19 with 42.1% and 42.5% to non-COVID-19). Conclusion(s): Although the differences between both groups are multifactorial, it's useful for self-evaluation observations, as well as sharing practices and outcomes for further analysis.
RESUMEN
Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.
El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.