Síndrome de Conn

Abstract

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Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

“…This is known as the Macklin effect. 5,7,9,10,12,18–23 If barotrauma is added to all this, due to the use of positive airway pressures (increased intra-alveolar pressure), 24,25 much more with IMV 1,2,5,6,22,25–29 than with NIRS, 1,5,27,28,30–34 the risk of alveolar wall rupture, and thus, the development of PM and PTX, is even higher.…”

“…Separately, the reported incidence of PM in COVID-19 patients ranges from 0.33% to 3.2% (0.33% 1 ; 0.64% 5 ; 1.5% 6 ; and 3.2% 7 ), and from 0.43% to 0.57% (0.43% 3 ; 0.51% 4 ; and 0.57% 8 ) if the origin is spontaneous, much higher compared to the general population, whose incidence of spontaneous PM is between 0.00238095% (1/42 000) and 0.125% (1/800). 9–12 And the reported incidence of PTX in COVID-19 patients ranges from 0.3% 13 to 1.0% 14 , and from 0.27% to 0.66% (0.27% 3 ; 0.31% 4 ; and 0.66% 15 ) if the origin is spontaneous, which is also much higher compared to the general population, whose incidence of spontaneous PTX is 0.0168% (1/5950). 16…”

“…This incidence of PM/PTX in COVID-19 patients increases as the degree of severity of COVID-19 increases, being especially high in the latest phase of COVID-19 (stage III), characterized by a systemic inflammatory hyperresponsiveness (“cytokine storm”) leading to acute respiratory distress syndrome (ARDS) 17 which, in turn, is responsible for diffuse and extensive alveolocapillary membrane injury and, thus, for a very important “lung fragility” that can lead to alveolar wall rupture, resulting in the occurrence of PM and PTX. 5,7,9,10,12,18–23 In addition, the most severe patients are the ones who most frequently have intense and repetitive coughing spells, 5,9,10,12,18–23 an abnormal respiratory mechanics, and a requirement for ventilatory support (barotrauma), 24,25 all of which also increase the risk of alveolar wall rupture. In this way, patients receiving invasive mechanical ventilation (IMV), the most severe, have the highest frequency of PM and/or PTX in the context of COVID-19, 1,2,5,6,22,25–29 followed by patients receiving noninvasive respiratory support (NIRS) (bilevel positive airway pressure [BiPAP], continuous positive airway pressure [CPAP], and high-flow nasal cannula [HFNC]) 1,5,27,28,30–34 and by patients receiving standard oxygen therapy (reservoir mask, single mask/Venturi mask, and conventional nasal cannula) or without the need for oxygen therapy (basal).…”