Pulmonary barotrauma in patient suffering from COVID-19

Carerj, Maria Ludovica; Bucolo, Giuseppe M.; Mazziotti, Silvio; Blandino, Alfredo; Booz, Christian; Cicero, Giuseppe; D’Angelo, Tommaso

doi:10.1016/j.heliyon.2022.e08745

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…This is known as the Macklin effect. 5,7,9,10,12,18–23 If barotrauma is added to all this, due to the use of positive airway pressures (increased intra-alveolar pressure), 24,25 much more with IMV 1,2,5,6,22,25–29 than with NIRS, 1,5,27,28,30–34 the risk of alveolar wall rupture, and thus, the development of PM and PTX, is even higher.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,9,10,12,18–23 In addition, the most severe patients are the ones who most frequently have intense and repetitive coughing spells, 5,9,10,12,18–23 an abnormal respiratory mechanics, and a requirement for ventilatory support (barotrauma), 24,25 all of which also increase the risk of alveolar wall rupture. In this way, patients receiving invasive mechanical ventilation (IMV), the most severe, have the highest frequency of PM and/or PTX in the context of COVID-19, 1,2,5,6,22,25–29 followed by patients receiving noninvasive respiratory support (NIRS) (bilevel positive airway pressure [BiPAP], continuous positive airway pressure [CPAP], and high-flow nasal cannula [HFNC]) 1,5,27,28,30–34 and by patients receiving standard oxygen therapy (reservoir mask, single mask/Venturi mask, and conventional nasal cannula) or without the need for oxygen therapy (basal). 3,4,8,35,36…”

Section: Introductionmentioning

confidence: 99%

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Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

García-Fadul¹

2023

J Intensive Care Med

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Introduction The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. Methods This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. Results A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. Conclusions In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

García-Fadul¹

2023

J Intensive Care Med

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“…El barotrauma inducido por la utilización de presiones positivas elevadas en la vía aérea en pacientes críticos que precisan de soporte ventilatorio también constituye otro elemento que, por aumento de la presión intraalveolar, puede ocasionar rotura alveolar y, por ende, NMMD, ES y NMTX 8,34 . Esto es más frecuente con el uso de VMI [9][10][11]21,[25][26][27][28]34 , aunque también puede suceder con el uso de dispositivos de soporte respiratorio no invasivo (SRNI) como la CPAP (presión positiva continua en la vía aérea) y la BPAP (presión positiva en dos niveles en la vía aérea), e incluso las gafas nasales de alto flujo (GNAF), puesto que todos ellos emiten una presión positiva al final de la espiración (efecto PEEP) 9,11,22,23,[27][28][29][35][36][37] . Un estudio de 353 pacientes críticos describió, efectivamente, una mayor incidencia de barotrauma (NMMD/ES/ NMTX) en el grupo de pacientes con SDRA por COVID-19 receptores de VMI, que fue del 17,35% (21/121), que en aquellos que habían recibido SRNI (GNAF, CPAP, BPAP), que fue del 4,74% (11/232) 27 .…”

Section: Nmmd Solounclassified

“…desarrollan NMMD/NMTX con una frecuencia considerablemente mayor 11,27,28 a los pacientes receptores de SRNI (GNAF, CPAP, BPAP) 9,11,22,23,[27][28][29][35][36][37] , seguido de los pacientes sin necesidad de VMI ni SRNI (NMMD y NMTX espontáneos), es decir, con necesidad de oxigenoterapia estándar o sin necesidad de oxigenoterapia alguna [12][13][14][15][16] . Asimismo, recalquemos que el factor más destacado que puede conducir a la aparición de NMMD es la «fragilidad pulmonar» derivada de la neumonía por SARS-CoV-2 y el SDRA asociado 25,26 .…”

Section: A B C D E Funclassified

El neumomediastino como complicación de la neumonía por SARS-CoV-2

Lorente-González¹,

Terán-Tinedo²,

Zevallos-Villegas³

et al. 2023

RPR

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La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la población general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento del gradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobre unos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo lo cual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía por SARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes con neumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensivos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, el neumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que se resuelve con tratamiento conservador.

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