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Medientyp:
E-Artikel
Titel:
Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty?
Beteiligte:
Lemmers, Daniel H.L.;
Abu Hilal, Mohammed;
Bnà, Claudio;
Prezioso, Chiara;
Cavallo, Erika;
Nencini, Niccolò;
Crisci, Serena;
Fusina, Federica;
Natalini, Giuseppe
Erschienen:
European Respiratory Society (ERS), 2020
Erschienen in:
ERJ Open Research, 6 (2020) 4, Seite 00385-2020
Sprache:
Englisch
DOI:
10.1183/23120541.00385-2020
ISSN:
2312-0541
Entstehung:
Anmerkungen:
Beschreibung:
BackgroundIn mechanically ventilated acute respiratory distress syndrome (ARDS) patients infected with the novel coronavirus disease (COVID-19), we frequently recognised the development of pneumomediastinum and/or subcutaneous emphysema despite employing a protective mechanical ventilation strategy. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in COVID-19 patients was higher than in ARDS patients without COVID-19 and if this difference could be attributed to barotrauma or to lung frailty.MethodsWe identified both a cohort of patients with ARDS and COVID-19 (CoV-ARDS), and a cohort of patients with ARDS from other causes (noCoV-ARDS).Patients with CoV-ARDS were admitted to an intensive care unit (ICU) during the COVID-19 pandemic and had microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period.ResultsPneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in three out of 163 (1.9%) patients with noCoV-ARDS (p<0.001). Mortality was 56.5% in CoV-ARDS patients with pneumomediastinum/subcutaneous emphysema and 50% in patients without pneumomediastinum (p=0.46).CoV-ARDS patients had a high incidence of pneumomediastinum/subcutaneous emphysema despite the use of low tidal volume (5.9±0.8 mL·kg−1 ideal body weight) and low airway pressure (plateau pressure 23±4 cmH2O).ConclusionsWe observed a seven-fold increase in pneumomediastinum/subcutaneous emphysema in CoV-ARDS. An increased lung frailty in CoV-ARDS could explain this finding more than barotrauma, which, according to its etymology, refers to high transpulmonary pressure.