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Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients.
Paternoster, Gianluca; Belmonte, Gianfranco; Scarano, Enrico; Rotondo, Pietro; Palumbo, Diego; Belletti, Alessandro; Corradi, Francesco; Bertini, Pietro; Landoni, Giovanni; Guarracino, Fabio.
  • Paternoster G; Department of Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy. Electronic address: paternostergianluca@gmail.com.
  • Belmonte G; Department of Radiology, San Carlo Hospital, Potenza, Italy.
  • Scarano E; Department of Radiology, San Carlo Hospital, Potenza, Italy.
  • Rotondo P; Department of Radiology, San Carlo Hospital, Potenza, Italy.
  • Palumbo D; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
  • Belletti A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Corradi F; Department of Surgical-Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.
  • Bertini P; Department of Anesthesia e Critical Care Medicine, Cardiothoracic-Vascular Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Italy.
  • Landoni G; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Guarracino F; Department of Anesthesia e Critical Care Medicine, Cardiothoracic-Vascular Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Italy.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumothorax / Barotrauma / COVID-19 / Mediastinal Emphysema Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Respir Med Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumothorax / Barotrauma / COVID-19 / Mediastinal Emphysema Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Respir Med Year: 2022 Document Type: Article