TY - JOUR
T1 - Incidence of pneumothorax and pneumomediastinum in 497 covid-19 patients with moderate–severe ards over a year of the pandemic
T2 - An observational study in an italian third level covid-19 hospital
AU - Tetaj, Nardi
AU - Garotto, Gabriele
AU - Albarello, Fabrizio
AU - Mastrobattista, Annelisa
AU - Maritti, Micaela
AU - Stazi, Giulia Valeria
AU - Marini, Maria Cristina
AU - Caravella, Ilaria
AU - Macchione, Manuela
AU - De Angelis, Giada
AU - ICU COVID-19 Study Group
AU - Busso, Donatella
AU - Di Lorenzo, Rachele
AU - Scarcia, Silvana
AU - Farina, Anna
AU - Centanni, Daniele
AU - Vargas, Joel
AU - Savino, Martina
AU - Carucci, Alessandro
AU - Antinori, Andrea
AU - Palmieri, Fabrizio
AU - D’offizi, Gianpiero
AU - Ianniello, Stefania
AU - Taglietti, Fabrizio
AU - Campioni, Paolo
AU - Vaia, Francesco
AU - Nicastri, Emanuele
AU - Girardi, Enrico
AU - Marchioni, Luisa
N1 - Funding Information:
Funding: This work was supported by INMI “Lazzaro Spallanzani” Ricerca Finalizzata COVID-2020-12371675 and Ricerca Corrente on emerging infections, both funded by the Italian Ministry of Health.
Funding Information:
This work was supported by INMI ?Lazzaro Spallanzani? Ricerca Finalizzata COVID-2020-12371675 and Ricerca Corrente on emerging infections, both funded by the Italian Ministry of Health.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - (1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). How-ever, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate–severe ARDS hospitalized in a year of the pan-demic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate–severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate– severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of baro-trauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive. ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate–severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate–severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation.
AB - (1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). How-ever, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate–severe ARDS hospitalized in a year of the pan-demic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate–severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate– severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of baro-trauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive. ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate–severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate–severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation.
KW - Barotrauma
KW - COVID-19
KW - COVID-19 waves
KW - Intensive care unit
KW - Invasive mechanical ventilation
KW - non-invasive ventilation
KW - Pneumomediastinum
KW - Pneumothorax
KW - Subcutaneous emphysema
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U2 - 10.3390/jcm10235608
DO - 10.3390/jcm10235608
M3 - Article
AN - SCOPUS:85120057518
VL - 10
SP - 1-11\
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
SN - 2077-0383
IS - 23
M1 - 5608
ER -