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HIGH INCIDENCE OF SPONTANEOUS PNEUMOTHORAX IN CRITICALLY ILL PATIENTS WITH SARS-COV-2
Chest ; 158(4):A1191-A1191, 2020.
Article in English | PMC | ID: covidwho-1385251
ABSTRACT
SESSION TITLE Disorders of the Pleura Posters SESSION TYPE Original Investigation Posters PRESENTED ON October 18-21, 2020

PURPOSE:

Spontaneous pneumothorax is a relatively common complication in critically ill patients with severe acute respiratory distress syndrome (ARDS). Limited data exists regarding pneumothorax in severe acute respiratory coronavirus 2 (SARS-CoV-2) patients. This study depicts cases of spontaneous pneumothorax in critically ill SARS-CoV-2 patients and explores the potential underlying mechanisms. METHOD(S) This is a retrospective cohort study of SARS-CoV-2 patients with severe ARDS admitted to a tertiary care center between March 9, 2020 to April 5, 2020. SARS-CoV-2 was diagnosed via polymerase chain reaction. Only patients on mechanical ventilation were analyzed. RESULT(S) A total of 22 patients with confirmed SARS-CoV-2 infection on mechanical ventilation were identified and analyzed. Out of these, 7 patients developed a spontaneous pneumothorax. The patients were predominantly male (86%) with an age range between 67 and 82 years old. Cough (100%) and shortness of breath (71%) were the most common presenting symptoms. Chronic obstructive pulmonary disease was not present in any of the patients. Pneumothoraxes were diagnosed 6 to 33 days after hospital admission. All 7 patients had subclavian central lines that were placed by 4 different providers with more than 15 years of critical care experience. All 7 patients had right sided pneumothoraxes of varying sizes but only 42% had right-sided lines. Remarkably, the mean peak inspiratory pressure (Ppeak) for these patients was 25 cm H2O and the mean positive end expiratory pressure (PEEP) was 11 cm H2O. Prone positioning was utilized in 57% of patients and 42% of patients received convalescent plasma. The mortality rate was 71% and the 2 patients who survived were discharged to long term acute care hospitals. CONCLUSION(S) Traditionally, ventilator associated pneumothorax is associated with a Ppeak greater than 40 cm H2O, which contrasts with the mean Ppeak of 25 cm H2O observed in this study. While iatrogenic pneumothoraces are common following subclavian central line placement, the majority of the pneumothoraces in this study occurred on the opposite side of the procedure. ARDS secondary to SARS-CoV-2 infection appears to have a completely different pathophysiology than that of traditional ARDS, which is typically managed with low PEEP and Ppeak. Utilizing the ARDSnet protocol in patients with ARDS secondary to SARS-CoV-2 may be deleterious. Further investigation is needed to evaluate this hypothesis. CLINICAL IMPLICATIONS ARDS secondary to SARS-CoV-2 appears to be distinct from ARDS caused by other disease processes and may have a different risk of pneumothorax development. As elderly, critically ill SARS-CoV-2 patients with ARDS have been found to have increased risk of death, identifying modifiable risks associated with the development of a spontaneous pneumothorax could help mitigate morbidity and mortality in this population. DISCLOSURES No relevant relationships by Andres Chacon Martinez, source=Web Response No relevant relationships by robert chait, source=Web Response No relevant relationships by Kai Chen, source=Web Response No relevant relationships by Nakeya Dewaswala, source=Web Response No relevant relationships by Katherine Hodgin, source=Web Response no disclosure on file for Jesus Pino;No relevant relationships by Fergie Ramos Tuarez, source=Web Response No relevant relationships by Renuka Reddy, source=Web ResponseCopyright © 2020 American College of Chest Physicians

Full text: Available Collection: Databases of international organizations Database: PMC Type of study: Observational study Language: English Journal: Chest Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: PMC Type of study: Observational study Language: English Journal: Chest Year: 2020 Document Type: Article