Comparison of radiographic pneumothorax and pneumomediastinum in COVID-19 vs. non-COVID-19 acute respiratory distress syndrome

Pulmonary air leak in COVID-19: time to learn from our mistakes

“…In Table 1 , we summarize the most important lessons we learned during the pandemic, which are indirectly supported by the findings of Knox et al [ 3 ]. Translating them to the bedside will hopefully make pulmonary air leaks uncommon even in patients with COVID-19.…”

“…In the study by Knox et al [ 3 ], 400 patients developed a pneumothorax or pneumomediastinum after receiving invasive mechanical ventilation with a plateau pressure up to 34 (30–40) cmH 2 O and positive end-expiratory pressure (PEEP) up to 16 (14–20) cmH 2 O. The driving (plateau minus PEEP) airway pressure probably exceeded 15 cmH 2 O in many of them.…”

“…Knox et al [ 3 ] aimed to address the first two questions in this issue of Intensive Care Medicine. They reviewed the chest imaging reports of 2211 patients with ARDS due to COVID-19 and 5522 with ARDS of different origin and found that the incidence of pneumothorax or pneumomediastinum in the two groups was similar, 24% and 22.5%.…”

“…In the following sections, we will briefly describe the pathogenesis of alveolar rupture, focus on mechanisms that may explain the findings of Knox et al [ 3 ], and conclude with the most important lessons we have recently learned on this topic.…”

Air leak, barotrauma susceptibility, and imaging in acute respiratory distress syndrome: novel application of an old tool

“…We read with great interest three recent articles published on Intensive Care Medicine [ 1 – 3 ] . In the first, Knox and colleagues present data on rate of pneumothorax/pneumomediastinum in 2211 patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) as compared with 5522 patients with non-COVID-19 ARDS [ 1 ]. Data from this large population confirm that these events occur more frequently in patients with COVID-19 ARDS as compared with non-COVID-19 ARDS [ 4 ].…”