Figures
- FIGURE 1
Chest computed tomography scan, performed in a patient with multiple ground-glass lesions and infiltrates (acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease 2019). The scan shows the Macklin effect due to alveolar rupture, air leakage and dissection along bronchovascular sheaths with pulmonary interstitial emphysema and pneumomediastinum, that extends widely along the muscle bundles of the chest and neck. A subcutaneous emphysema and extension of pneumomediastinum in the abdomen is also seen.
Tables
- TABLE 1
Baseline characteristics on first day of mechanical ventilation and outcomes in patients with acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease (COVID-19) and ARDS from other diseases
Variables CoV-ARDS noCoV-ARDS p-value Subjects n 169 163 Age years 66 (59–71) 72 (62–78) <0.001 Male sex 133 (78.7) 106 (65.4) 0.007 Body mass index kg·m−2 28 (25–31) 27 (24–31) 0.02 Diabetes mellitus 26 (15.4) 47 (29) 0.003 Arterial hypertension 90 (53.3) 96 (59.3) 0.27 COPD 4 (2.4) 22 (13.5) <0.001 Positive end-expiratory pressure cmH2O 12 (10–14) 8 (5–9) <0.001 Peak airway pressure cmH2O 30±5 22±6 <0.001 Plateau airway pressure cmH2O 23±4 19±3 <0.001 pH 7·29±0.12 7·33±0.14 0.15 PaCO2 mmHg 56±16 46±12 <0.001 Compliance of the respiratory system mL·cmH2O−1 28 (22–34) 35 (25–43) <0.001 Minute ventilation L·min−1 8.8±1.3 8.7±2.3 0.62 Corrected minute ventilation L·min−1 12.4 (9.3–15) 9.6 (7.5–11.8) <0.001 PaO2/FIO2 mmHg 111 (86–153) 140 (100–198) <0.001 Tidal volume/ideal body weight mL·kg−1 5.9±0.8 6.6±1.3 <0.001 Length of stay in intensive care unit 10 (5–18) 7 (3–20) 0.22 Length of stay in hospital 15 (9–24) 20 (11–33) 0.002 In-hospital mortality 86 (50.9) 43 (26.6) <0.001 Pneumomediastinum/subcutaneous emphysema 23 (13.6) 3 (1.9) <0.001 Data are presented as median (interquartile range), n (%) or mean±sd, unless otherwise stated. CoV-ARDS: ARDS from COVID-19; noCoV-ARDS: ARDS secondary to other diseases; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.
- TABLE 2
Baseline characteristics and outcomes in patients with acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease (COVID-19) with and without pneumomediastinum/subcutaneous emphysema (P/SE)
Variables Without P/SE With P/SE p-value Subjects n 146 23 Age years 67 (59–71) 64 (60–70) 0.24 Male sex 118 (80.8) 15 (65) 0.09 Body mass index kg·m−2 28 (26–31) 27 (25–31) 0.29 Diabetes mellitus 23 (15.8) 3 (13) 0.74 Arterial hypertension 79 (54.1) 11 (47.8) 0.58 COPD 4 (2.7) 0 (0) 1 Positive end-expiratory pressure cmH2O 12 (10–14) 12 (8–15) 0.72 Peak airway pressure cmH2O 29±5 30±5 0.56 Plateau airway pressure cmH2O 23±4 24±6 0.80 pH 7.28±0.12 7.33±0.11 0.07 PaCO2 mmHg 57±16 53±15 0.26 Compliance of the respiratory system mL·cmH2O−1 27 (22–33) 28 (22–36) 0.55 Minute ventilation L·min−1 8.9±1.3 8.3±1.1 0.04 Corrected minute ventilation L·min−1 12.7 (9.4–15) 9.9 (8.4–13.1) 0.07 PaO2/FIO2 mmHg 114 (86–153) 105 (81–137) 0.21 Tidal volume/ideal body weight mL·kg−1 5.9±0.8 6.1±0.9 0.23 Length of stay in intensive care unit 9 (5–18) 11 (6–21) 0.44 Length of stay in hospital 14 (8–23) 18 (12–28) 0.18 In-hospital mortality 73 (50) 13 (56.5) 0.46 Data are presented as median (interquartile range), n (%) or mean±sd, unless otherwise stated. PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.
- TABLE 3
Ventilatory variables of patients with acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease (COVID-19) who developed pneumomediastinum/subcutaneous emphysema (n=23)
Variables On the first day of mechanical ventilation On the day of P/SE p-value Positive end-expiratory pressure cmH2O 12 (8–15) 9 (6–13) 0.002 Peak airway pressure cmH2O 30±5 29±5 0.08 Plateau airway pressure cmH2O 24±5 22±4 0.045 pH 7.32±0.09 7.33±0.13 0.4 PaCO2 mmHg 54±14 53±12 0.77 Compliance of the respiratory system mL·cmH2O−1 25 (22–34) 33 (27–40) 0.13 Minute ventilation L·min−1 8.4±1.2 8.9±2.1 0.13 Corrected minute ventilation L·min−1 11.5±4 12.1±4.1 0.45 PaO2/FIO2 mmHg 108±33 131±76 0.13 Tidal volume/ideal body weight mL·kg−1 6±0.9 6.7±1.7 0.008 Data are presented as median (interquartile range) or mean±sd, unless otherwise stated. P/SE: pneumomediastinum/subcutaneous emphysema; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.
