The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax

Simioli, Francesca; Annunziata, Anna; Polistina, Giorgio Emanuele; Coppola, Antonietta; Spirito, Valentina Di; Fiorentino, Giuseppe

doi:10.3390/healthcare9060620

Cited by 18 publications

(33 citation statements)

References 18 publications

(18 reference statements)

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“…On the other hand, the case reported by Sun et al presented the signs of emphysema during hospitalization where the patient had already received oxygen therapy at 20 L/min [ 5 ]. COVID-19 itself and its treatment by excessive oxygen flow increase during desaturation could explain the occurrence of emphysema» [ 6 ]. The pathogenesis of emphysema primarily involves an inflammatory process in the lungs during various infections.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the therapeutic management, our patient was receiving oxygen therapy and surgery. The emphysema described in the literature was treated with oxygen therapy only [ 5 ]: non-invasive ventilation, high Flow Nasal Cannula and invasive mechanical ventilation [ 6 ]. In our case, surgery was necessary in view of the presence of signs of poor tolerance of the GE.…”

Section: Discussionmentioning

confidence: 99%

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Giant compressive emphysema: a rare complication of COVID-19

et al. 2021

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Background The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities. Case presentation A 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy. Conclusion The COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Giant compressive emphysema: a rare complication of COVID-19

et al. 2021

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“…The prolonged use of NIV and to a lesser extent HFNO in patients with COVID-19 is associated with the risk of pressure injury, especially in the nasal area, and with an increased risk of pulmonary barotrauma. 39 Helmet-NIV eliminates the risk of pressure injury associated with face-mask interfaces, but may uncommonly be associated with other pressure injuries around the neck seal and underneath the axillary straps.…”

Section: Other Safety Concernsmentioning

confidence: 99%

High-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19

Al‐Dorzi¹,

Kress²,

Arabi³

2022

Critical Care Clinics

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High-flow nasal oxygen (HFNO) and non-invasive ventilation (NIV) via face-mask or helmet have been increasingly used in the management of acute hypoxemic respiratory failure (AHRF) due to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. However, their use carries the risk of delaying intubation and nosocomial infection transmission. To this date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF due to COVID-19. A randomized controlled trial among patients with COVID-19 showed that helmet NIV versus HFNO led to a lower intubation rate but no difference in survival or the duration of respiratory support. The RECOVERY respiratory support trial demonstrated that CPAP, but not HFNO reduced a composite outcome of tracheal intubation or mortality within 30-days compared with conventional oxygen therapy. Additional trials are ongoing and are evaluating different aspects of noninvasive respiratory support in patients with AHRF due to COVID-19.

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“…Indeed, bilateral, extensive lung involvement and histopathological findings of diffuse alveolar damage and fibromyxoid cell exudates have been considered structural factors that predispose patients, who have overcome a severe case of COVID-19, to impaired lung reconstruction [ 11 ]. Of interest, patients with severe COVID-19 leading to ARDS may also show full thickness tracheal/large airway cartilage lesions with fibrous-hyaline degeneration; this pathologic feature is uncommon in individuals with non-COVID-19 ARDS, and may have contributed to the unexpectedly high prevalence of pneumomediastinum reported during the second wave of the COVID-19 pandemic [ 12 , 13 ]. The major morbidity and mortality from COVID-19 is due to acute viral pneumonitis that evolves into ARDS.…”

Section: Introductionmentioning

confidence: 99%

The Mortality Risk and Pulmonary Fibrosis Investigated by Time-Resolved Fluorescence Spectroscopy from Plasma in COVID-19 Patients

Wybranowski

Pyskir

Bosek

et al. 2022

JCM

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A method of rapidly pointing out the risk of developing persistent pulmonary fibrosis from a sample of blood is extraordinarily needed for diagnosis, prediction of death, and post-infection prognosis assessment. Collagen scar formation has been found to play an important role in the lung remodeling following SARS-CoV-2 infection. For this reason, the concentration of collagen degradation products in plasma may reflect the process of lung remodeling and determine the extent of fibrosis. According to our previously published results of an in vitro study, an increase in the concentration of type III collagen degradation products in plasma resulted in a decrease in the fluorescence lifetime of plasma at a wavelength of 450 nm. The aim of this study was to use time-resolved fluorescence spectroscopy to assess pulmonary fibrosis, and to find out if the lifetime of plasma fluorescence is shortened in patients with COVID-19. The presented study is thus far the only one to explore the fluorescence lifetime of plasma in patients with COVID-19 and pulmonary fibrosis. The time-resolved spectrometer Life Spec II with the sub-nanosecond pulsed 360 nm EPLED® diode was used in order to measure the fluorescence lifetime of plasma. The survival analysis showed that COVID-19 mortality was associated with a decreased mean fluorescence lifetime of plasma. The AUC of mean fluorescence lifetime in predicting death was 0.853 (95% CI 0.735–0.972, p < 0.001) with a cut-off value of 7 ns, and with 62% sensitivity and 100% specificity. We observed a significant decrease in the mean fluorescence lifetime in COVID-19 non-survivors (p < 0.001), in bacterial pneumonia patients without COVID-19 (p < 0.001), and in patients diagnosed with idiopathic pulmonary fibrosis (p < 0.001), relative to healthy subjects. Furthermore, these results suggest that the development of pulmonary fibrosis may be a real and serious problem in former COVID-19 patients in the future. A reduction in the mean fluorescence lifetime of plasma was observed in many patients 6 months after discharge. On the basis of these data, it can be concluded that a decrease in the mean fluorescence lifetime of plasma at 450 nm may be a risk factor for mortality, and probably also for pulmonary fibrosis in hospitalized COVID-19 patients.

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The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax

Cited by 18 publications

References 18 publications

Giant compressive emphysema: a rare complication of COVID-19

Giant compressive emphysema: a rare complication of COVID-19

High-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19

The Mortality Risk and Pulmonary Fibrosis Investigated by Time-Resolved Fluorescence Spectroscopy from Plasma in COVID-19 Patients

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