Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients.
Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients.
复制标题
机械通气 COVID-19 患者气胸/纵隔气肿的预测因素。
DOI：
10.1053/j.jvca.2021.02.008
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发表时间：
2021-12
影响因子：
2.8
通讯作者：
COVID-BioB Study Group
中科院分区：
文献类型：
--
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
目的探讨2019冠状病毒病（COVID-19）急性呼吸窘迫综合征（ARDS）患者气胸(PNX)/纵隔气肿（PMD）的发生率、预测因素和预后。观察性研究。三级保健大学医院。116例有创通气重症COVID-19急性呼吸窘迫综合征患者作者收集了人口统计学、机械通气、影像学、实验室和结局数据。主要终点是PNX/PMD的发生率。采用多元逻辑回归分析来确定PNX/PMD的预测因素。PNX/PMD共发生28例（24.1%），其中22例发展为PNX(19.0%)， 13例发展为PMD（11.2%）。从插管到PNX/PMD发展的平均时间为14±11天。作者发现，在发生PNX/PMD的患者和未发生PNX/PMD的患者之间，机械通气参数没有显著差异。两组机械通气参数均在保护性通气推荐范围内。95%的PNX/PMD患者在基线计算机断层扫描中具有麦克林效应（与支气管血管鞘相邻的线性空气集合），并且在重症监护病房（ICU）入院时倾向于有更高的肺部受累（肺部水肿影像学评估评分32.2±13.4 v 18.7±9.8，无PNX/PMD患者，p = 0.08）。从症状出现到插管的时间和ICU入院后第2天总胆红素的时间是PNX/PMD的唯一独立预测因子。发生PNX/PMD的患者死亡率为60.7%，而未发生PNX/PMD的患者死亡率为38.6% （p = 0.04）。PNX/PMD常见于需要机械通气的COVID-19 ARDS患者，并与死亡率增加相关。尽管使用保护性机械通气，PNX/PMD的发展似乎仍会发生，并且具有放射学预测标志。
To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Observational study. Tertiary-care university hospital. One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. 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. 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). 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.
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影响因子：
120.7
作者：
Cavalcanti, Alexandre Biasi;Suzumura, Erica Aranha;Ribeiro de Carvalho, Carlos Roberto
通讯作者：
Ribeiro de Carvalho, Carlos Roberto
影响因子：
2.8
作者：
De Cobelli F;Palumbo D;Ciceri F;Landoni G;Ruggeri A;Rovere-Querini P;D'Angelo A;Steidler S;Galli L;Poli A;Fominskiy E;Calabrò MG;Colombo S;Monti G;Nicoletti R;Esposito A;Conte C;Dagna L;Ambrosio A;Scarpellini P;Ripa M;Spessot M;Carlucci M;Montorfano M;Agricola E;Baccellieri D;Bosi E;Tresoldi M;Castagna A;Martino G;Zangrillo A
通讯作者：
Zangrillo A
影响因子：
38.9
作者：
Ferrando, Carlos;Suarez-Sipmann, Fernando;Villar, Jesus
通讯作者：
Villar, Jesus
DOI：
10.1164/rccm.201605-1081cp
发表时间：
2017-02-15
影响因子：
24.7
作者：
Brochard, Laurent;Slutsky, Arthur;Pesenti, Antonio
通讯作者：
Pesenti, Antonio
影响因子：
3
作者：
Fominskiy, Evgeny, V;Scandroglio, Anna Mara;Zangrillo, Alberto
通讯作者：
Zangrillo, Alberto