Subcutaneous Emphysema, Pneumomediastinum, and Pneumothorax in Critically Ill Patients With Coronavirus Disease 2019: A Retrospective Cohort Study

Jones, Eben; Gould, Allon; Pillay, Timesh D; Khorasanee, Reza; Sykes, Richard; Bazo‐Alvarez, Juan Carlos; Cox, Charlie; Shurovi, Badrun; Isted, Alexander; Simpson, Thomas; Jennings, Mick; Breeze, Richard; Khaliq, Waqas

doi:10.1097/cce.0000000000000210

Cited by 33 publications

(36 citation statements)

References 27 publications

(28 reference statements)

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“…Jones et al reported Seven out of eight patients (87.5%) in the barotrauma group had received NIPPV as the initial mode of advanced respiratory support, compared with 27 of 75 (36.0%) in the non-barotrauma group (p=0.007). 17 Applying the universally accepted ARDS Network guidelines to ventilate ARDS patients using…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Rates of NIPPV-associated barotrauma are not known but are reportedly rare in COVID-19 related ARDS. 17,21,22 However, in NIPPV, the tidal volumes and transpulmonary pressure are dependent on the patient's spontaneous respiratory effort, which may result in highly variable and fluctuant transpulmonary pressures that cannot be limited or controlled, 23,24 which may result in selfinflicted PBT in patients with ARDS. Higher incidence of PBT in NIPPV might be also attributed to the limited use of sedation and muscle relaxant in NIPPV group compared to IPPV which might have impacted patient-ventilator desynchrony, and subsequently higher risk of developing PBT.…”

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confidence: 99%

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Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Hamouri¹,

Samrah²,

Albawaih³

et al. 2021

IJGM

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This study aims to determine the incidence and outcome of COVID-19 patients who required positive pressure ventilation (PPV) and subsequently developed pulmonary barotrauma (PBT). Also, to investigate the risk factors and predictors of these complications to better understand the disease pathogenesis. Patients and Methods: This retrospective analysis enrolled all adult COVID-19 patients admitted through the period from October 1, 2020, to December 31, 2020. All patients who received any form of PPV were included. Patients were then divided into two groups based on PBT development, including subcutaneous emphysema, pneumothorax, and pneumomediastinum. Medical records of all patients were reviewed. Patients' demographics, laboratory data on admission, respiratory support modes, surgical interventions, and outcomes were collected and analyzed. Results: In the specified period, 1095 patients were hospitalized due to COVID-19 illness. A total of 239 (21.8%) of all admitted patients received PPV. PBT accounted for 21.3% (51/ 239) of the study cohort. While both groups were equally exposed to the same modes of PPV, receiving invasive ventilation significantly correlated with decreased PBT odds (OR = 0.891; 95% CI, 0.803-0.988; p=0.029). PBT patients were significantly younger (p<0.001). Diabetes mellitus was found to have a protective effect on developing PBT (OR = 0.867; 95% CI, 0.782-0.962), while PO 2 /FIO 2 ratio was inversely associated with higher odds of developing PBT in both univariate and multivariate analyses (p=0.03 and p=0.019, respectively). Conclusion: COVID-19-infected patients are at a higher risk of developing PBT. Invasive positive pressure ventilation was associated with less PBT compared to noninvasive ventilation and delaying intubation does not seem to reduce the risk of pulmonary barotrauma.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Hamouri¹,

Samrah²,

Albawaih³

et al. 2021

IJGM

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“…They assumed that barotrauma in COVID-19 patients is related to longer management prior to critical care admission and the use of CPAP or NIV. However, the manuscript does not specify if the chest CT scans were performed before or after CPAP management, NIV, and invasive mechanical ventilation (16).…”

Section: Discussionmentioning

confidence: 99%

Frequency and Risk Factors for Spontaneous Pneumomediastinum in COVID-19 Patients

et al. 2021

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Background: Spontaneous pneumomediastinum (SPM) is an uncommon condition in COVID-19 patients. No information about outcome or risk factors is available at the time. The aim of this research is to report on the frequency and risk factors of spontaneous pneumomediastinum in COVID-19 patients.Materials and Methods: An unmatched case-control study was carried out in a tertiary health-care facility for patients with COVID-19. Electronic files were reviewed to identify patients with confirmed COVID-19 infection by RT-PCR. Univariate analysis was used to describe demographic data. Mean differences were calculated using the Mann-Whitney test. Frequency and odds ratios were calculated by standard operations.Results: A total of 271 patients were included in the study. Nine patients showed spontaneous pneumomediastinum and four of them presented associated spontaneous pneumothorax. The most common risk factors associated with poor outcomes in COVID-19 patients were not considered as risk factors for spontaneous pneumomediastinum development.Conclusion: Spontaneous pneumomediastinum is an uncommon clinical feature in COVID-19 patients. More research is necessary to formulate statements regarding prevalence, risk factors, and outcome.

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“…Several mechanisms may explain increase incidence of barotrauma in COVID-19. Pathologic processes such as interstitial pneumonia, consolidation, and in-situ thrombosis, all seen in COVID-19 pneumonia, increases the friability of lung parenchyma and pleura, thus increasing the risk of fistulation between the distal airways and pleural space or hilum [ 3 ].The peripheral predominance of COVID-19 pneumonia and its propensity to cause cystic change, may further explain increase risk in these patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The interstitial air may rupture into pleural space (pneumothorax) or into the mediastinum (pneumomediastinum). Air may collect in extra alveolar spaces forming lung cysts [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Ventilator associated lung injury in severe COVID-19 pneumonia patients – Case Reports

Gupta¹,

Alkandari²,

Mohammed³

et al. 2021

European Journal of Radiology Open

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Management of severe coronavirus disease 2019 requires advanced respiratory support modalities including invasive mechanical ventilation (IMV), continuous positive airway pressure (C-PAP), and non-invasive ventilation ((NIV). IMV leads to either subtle forms of lung injury (pulmonary edema, lung cysts) or more severe form of lung injury manifested as subcutaneous emphysema, pneumomediastinum, and pneumothorax (herein collectively termed barotrauma). We have described two cases showing the two end of spectrum of ventilator associated lung injury (VALI).

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Subcutaneous Emphysema, Pneumomediastinum, and Pneumothorax in Critically Ill Patients With Coronavirus Disease 2019: A Retrospective Cohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 33 publications

References 27 publications

Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Frequency and Risk Factors for Spontaneous Pneumomediastinum in COVID-19 Patients

Ventilator associated lung injury in severe COVID-19 pneumonia patients – Case Reports

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