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Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review.
Belletti, Alessandro; Pallanch, Ottavia; Bonizzoni, Matteo Aldo; Guidi, Leonardo; De Cobelli, Francesco; Landoni, Giovanni; Zangrillo, Alberto; De Bonis, Michele; Palumbo, Diego.
  • Belletti A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Pallanch O; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Bonizzoni MA; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Guidi L; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • De Cobelli F; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
  • Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
  • Zangrillo A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
  • De Bonis M; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Palumbo D; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Respir Med ; 210: 107178, 2023.
Article in English | MEDLINE | ID: covidwho-2251731
ABSTRACT

INTRODUCTION:

Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to further characterize the clinical role of Macklin.

METHODS:

PubMed, Scopus, Cochrane Central Register and Embase were searched for studies reporting data on Macklin. Studies without data on chest CT, pediatric studies, non-human and cadaver studies, case reports and series including <5 patients were excluded. The primary objective was to assess the number of patients with Macklin sign and barotrauma. Secondary objectives were occurrence of Macklin in different populations, clinical use of Macklin, prognostic impact of Macklin.

RESULTS:

Seven studies enrolling 979 patients were included. Macklin was present in 4-22% of COVID-19 patients. It was associated with barotrauma in 124/138 (89.8%) of cases. Macklin sign preceded barotrauma in 65/69 cases (94.2%) 3-8 days in advance. Four studies used Macklin as pathophysiological explanation for barotrauma, two studies as a predictor of barotrauma and one as a decision-making tool. Two studies suggested that Macklin is a strong predictor of barotrauma in ARDS patients and one study used Macklin sign to candidate high-risk ARDS patients to awake extracorporeal membrane oxygenation (ECMO). A possible correlation between Macklin and worse prognosis was suggested in two studies on COVID-19 and blunt chest trauma.

CONCLUSIONS:

Increasing evidence suggests that Macklin sign anticipate barotrauma in patients with ARDS and there are initial reports on use of Macklin as a decision-making tool. Further studies investigating the role of Macklin sign in ARDS are justified.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Thoracic Injuries / Barotrauma / Wounds, Nonpenetrating / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Child / Humans Language: English Journal: Respir Med Year: 2023 Document Type: Article Affiliation country: J.rmed.2023.107178

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Thoracic Injuries / Barotrauma / Wounds, Nonpenetrating / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Child / Humans Language: English Journal: Respir Med Year: 2023 Document Type: Article Affiliation country: J.rmed.2023.107178