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.
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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DOI：
10.3390/jcm10235608
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发表时间：
2021-11-29
影响因子：
3.9
通讯作者：
Icu Covid-Study Group
中科院分区：
文献类型：
--
作者：
Tetaj N;Garotto G;Albarello F;Mastrobattista A;Maritti M;Stazi GV;Marini MC;Caravella I;Macchione M;De Angelis G;Busso D;Di Lorenzo R;Scarcia S;Farina A;Centanni D;Vargas J;Savino M;Carucci A;Antinori A;Palmieri F;D'Offizi G;Ianniello S;Taglietti F;Campioni P;Vaia F;Nicastri E;Girardi E;Marchioni L;Icu Covid-Study Group
(1)背景：COVID-19是急性呼吸窘迫综合征（ARDS）的新病因。事实上，随着COVID-19大流行导致ARDS病例的增加，气胸（PNX）和纵隔肺炎（PNM）病例的发生率也有所增加。然而，PNX/PMN在这些患者中的发病率和预测因素目前尚不清楚，甚至相互矛盾。(2)方法：本观察性研究分析大流行一年内住院的COVID-19合并中重度ARDS患者气压损伤（PNX/PNM）发生率，并重点分析该年内发生的三波，并采用正压通气（PPV）治疗。我们收集了人口统计和临床数据。(3)结果：在此期间，40例患者发生PNX/PNM。在一年内住院的所有COVID-19患者中，气压创伤的总发生率为1.6%，而在PPV中重度ARDS患者中，气压创伤的总发生率为7.2%，每1000个正压呼吸机日发生3.8次事件。三波期间中重度ARDS COVID-19患者气压损伤发生率分别为7.8%、7.4%和8.7%。单独使用无创呼吸支持治疗与9.1%的气压损伤发生率和每1000个无创呼吸日2.6个事件相关，其中95%在事件发生后因呼吸参数恶化而入住ICU。ICU COVID-19患者有创通气1年内气压创伤发生率为5.8%，每1000有创通气日2.7次。压力创伤组和非压力创伤组在人口统计学和临床特征上无显著差异。气压创伤组的死亡率（17例死亡，47.2%）高于非气压创伤组（170例死亡，37%），但差异无统计学意义（p = 0.429）。(4)结论：中重度ARDS COVID-19患者PNX/PNM的发生率在一年内三波间无显著性差异，与前期ARDS患者无明显差异。如果采用保护性通气策略，气压创伤似乎不会显著增加COVID-19合并中重度ARDS患者的死亡率。COVID-19患者在无创通气中发生气压创伤的风险，因为该事件增加了进入重症监护病房（ICU）和插管的可能性。
(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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影响因子：
8.1
作者：
Lichtenstein DA
通讯作者：
Lichtenstein DA
影响因子：
3.2
作者：
Grieco, Domenico L.;Menga, Luca S.;Antonelli, Massimo
通讯作者：
Antonelli, Massimo
影响因子：
4.1
作者：
Griffiths, Mark J. D.;McAuley, Danny Francis;Baudouin, Simon V.
通讯作者：
Baudouin, Simon V.
影响因子：
2.1
作者：
Galbois, A.;Zorzi, L.;Guidet, B.
通讯作者：
Guidet, B.
机械通气 COVID-19 患者气胸/纵隔气肿的预测因素。
影响因子：
2.8
作者：
Belletti A;Palumbo D;Zangrillo A;Fominskiy EV;Franchini S;Dell'Acqua A;Marinosci A;Monti G;Vitali G;Colombo S;Guazzarotti G;Lembo R;Maimeri N;Faustini C;Pennella R;Mushtaq J;Landoni G;Scandroglio AM;Dagna L;De Cobelli F;COVID-BioB Study Group
通讯作者：
COVID-BioB Study Group