Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

Belletti, Alessandro; Landoni, Giovanni; Zangrillo, Alberto

doi:10.1016/j.rmed.2021.106552

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…A study investigating PTX alone in COVID-19 also found the incidence to be 0.56%. 15 The overall mortality of 52% from air leak, in our centre, is in line with some studies, 16 , 17 but higher that reported in others. 3 The mortality difference in our patients with and without air leak is not statistically significant.…”

Section: Discussionsupporting

confidence: 92%

Incidence and Clinical Features of Pneumomediastinum and Pneumothorax in COVID-19 Pneumonia

Muhammad

Mehta²,

Shaw

et al. 2022

J Intensive Care Med

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Background Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here “air leak”, are now well described complications of severe COVID-19 pneumonia across several case series. The incidence is thought to be approximately 1% but is not definitively known. Objectives To report the incidence and describe the demographic features, risk factors and outcomes of patients with air leak as a complication of COVID-19. Methods A retrospective observational study on all adult patients with COVID-19 admitted to Watford General Hospital, West Hertfordshire NHS Trust between March 1st 2020 and Feb 28th 2021. Patients with air leak were identified after reviewing both chest radiographs (CXRs) and axial imaging (CT Thorax) with confirmatory radiology reports inclusive of the terms PTX and/or PM. Results Air leak occurred with an incidence of 0.56%. Patients with air leak were younger and had evidence of more severe disease at presentation, including a higher median CRP and number of abnormal zones affected on chest radiograph. Asthma was a significant risk factor in the development of air leak (OR 13.4 [4.7-36.4]), both spontaneously and following positive pressure ventilation. CPAP and IMV were also associated with a greater than six fold increase in the risk of air leak (OR 6.4 [2.5-16.6] and 9.8 [3.7-27.8] respectively). PTX, with or without PM, in the context of COVID-19 pneumonia was almost universally fatal whereas those with alone PM had a lower risk of death. Conclusion Despite the global vaccination programme, patients continue to develop severe COVID-19 disease and may require respiratory support. This study demonstrates the importance of identifying that deterioration in such patients may be resultant from PTX or PM, particularly in asthmatics and those managed with positive pressure ventilation.

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Section: Discussionsupporting

confidence: 92%

Incidence and Clinical Features of Pneumomediastinum and Pneumothorax in COVID-19 Pneumonia

Muhammad

Mehta²,

Shaw

et al. 2022

J Intensive Care Med

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“…These data are in line with those identified in our recent systematic review, which confirms a 61.6% pooled estimate for mortality in COVID-19 patients who develop barotrauma [ 10 , 11 ]. Of note, we observed that the overall rate of barotrauma is more frequent in COVID-19 patients, with 14.7% of the patients having at least one barotrauma event (pooled estimates, 16.1%; 95% confidence interval [CI], 11.8%–20.4%), whilst in non-COVID-19 ARDS patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, −2.1%–13.5%) [ 10 ].…”

Section: Main Textsupporting

confidence: 91%

An increasing rate of pneumomediastinum in non-intubated COVID-19 patients: The role of steroids and a possible radiological predictor

Guidi

Belletti

Palumbo

et al. 2022

Respiratory Investigation

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“…Patients on invasive mechanical ventilation were controlled by sedation, analgesia, and curarization when necessary, so that they could be optimally adapted to protective mechanical ventilation by choosing an optimal driving pressure and plateau pressure (≤14 cm H 2 O and ≤30 cm H 2 O, when it was possible) in order to reduce the risk of barotrauma [ 26 ]. This may be the reason why we have had a lower incidence in intubated patients than that documented in some other recent studies [ 27 , 28 ]. Furthermore, the incidence of barotrauma due to iatrogenic causes in the ICU (2.2%), mostly from thoracentesis and fibrobronchoscopy, was no higher than that documented in several studies [ 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 43%

Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital

Tetaj

Garotto

Albarello

et al. 2021

JCM

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(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). However, 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 pandemic, 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 barotrauma 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.

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Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

Cited by 11 publications

References 26 publications

Incidence and Clinical Features of Pneumomediastinum and Pneumothorax in COVID-19 Pneumonia

Incidence and Clinical Features of Pneumomediastinum and Pneumothorax in COVID-19 Pneumonia

An increasing rate of pneumomediastinum in non-intubated COVID-19 patients: The role of steroids and a possible radiological predictor

Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital

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