Inserting a Drainage Strip into the Pre-tracheal Space to Treat Tension Pneumomediastinum: A Case-control Study

Abstract

Background: A Severe tension pneumomediastinum can result in respiratory and circulatory dysfunction. Common etiologies include severe pneumonia such as COVID-19 pneumonia, asthma, excessive pressure from a ventilator, etc. we describe a method for draining tension pneumomediastinum by inserting a drainage strip into the pre-tracheal space.Methods:Design: Case-control.Setting: Data from a medical institution in southern China.Participants: 30 patients with tension pneumomediastinum and comorbid type II respiratory failure.Interventions: 15 patients (surgery group) were treated with a drainage strip being inserted into the pre-tracheal space while other 15 patients (control group) were treated without drainage.Outcome measures: Arterial blood pO2 and pCO2 after 30 minutes and 12 hours of mechanical ventilation, total duration of mechanical ventilation, and chest radiography results after 12 hours of mechanical ventilation.Results: Chest radiography after 12 hours of mechanical ventilation showed that the pneumomediastinum basically disappeared in the surgery group but did not decrease significantly in the control group. The arterial blood pCO2 after 12 hours of mechanical ventilation and total duration of mechanical ventilation were significantly lower in the surgery group than in the control group (95% CI -3.31 to -1.36, p<0.001; 95% CI -5.56 to -2.84, p<0.001), while the arterial blood pO2 after 12 hours of mechanical ventilation was significantly higher in the surgery group than in the control group (95% CI 1.76 to 7.57, p=0.004). There were no significant intergroup differences in other variables. No recurrence occurred in either group during 7–14 days after discharge, and all patients recovered.Conclusions: Our method for draining tension pneumomediastinum improved respiratory function and shortened mechanical ventilation duration.Trial registration: ChiCTR2000039496Data sharing statement: Technical appendix, statistical code, and dataset available from the FigShare repository, https://doi.org/10.6084/m9.figshare.13487295.