Abstract
Objective: To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).
Design: Observational study.
Setting: Tertiary-care university hospital.
Participants: One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS.
Interventions: The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD.
Measurements and main results: PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04).
Conclusion: PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.
Keywords: COVID-19; Macklin effect; SARS-CoV-2; acute respiratory distress syndrome; barotrauma; mechanical ventilation; pneumothorax.
【저자키워드】 COVID-19, SARS-CoV-2, acute respiratory distress syndrome, mechanical ventilation, Macklin effect, barotrauma, Pneumothorax., 【초록키워드】 coronavirus disease, ARDS, intensive care, lung involvement, Ventilation, intubation, predictors, outcome, observational study, ICU, Laboratory, Computed tomography, Critically ill, Patient, ICU admission, predictor, incidence, assessment, development, Admission, Protective, acute respiratory distress, COVID-19 patient, symptom onset, total bilirubin, no significant difference, university hospital, syndrome, increased mortality, multiple logistic regression, parameter, measurement, time, limit, identify, performed, radiologic, collected, occurred, linear, determine, occur, analysis, baseline, in both groups, independent predictor, invasively ventilated patient, Mechanical, with COVID-19,