RT Journal Article
SR Electronic
T1 Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty?
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00385-2020
DO 10.1183/23120541.00385-2020
A1 Daniel H.L. Lemmers
A1 Mohammed Abu Hilal
A1 Claudio Bnà
A1 Chiara Prezioso
A1 Erika Cavallo
A1 Niccolò Nencini
A1 Serena Crisci
A1 Federica Fusina
A1 Giuseppe Natalini
YR 2020
UL http://openres.ersjournals.com/content/early/2020/09/17/23120541.00385-2020.abstract
AB Background In mechanically ventilated Acute Respiratory Distress Syndrome (ARDS) patients with 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.Methods We identified the cohort of patients with ARDS and COVID-19 (“CoV-ARDS”), and the cohort of patients with ARDS from other causes (“noCoV-ARDS”).Patients with CoV-ARDS were admitted to ICU during the COVID-19 pandemic and had microbiologically confirmed SARS-CoV-2 infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period.Results Pneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in 3 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).Conclusions We 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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Lemmers has nothing to disclose.Conflict of interest: Dr. Abu Hilal has nothing to disclose.Conflict of interest: Dr. Bna has nothing to disclose.Conflict of interest: Dr. Prezioso has nothing to disclose.Conflict of interest: Dr. Cavallo has nothing to disclose.Conflict of interest: Dr. Nencini has nothing to disclose.Conflict of interest: Dr. Crisci has nothing to disclose.Conflict of interest: Dr. Fusina has nothing to disclose.Conflict of interest: Dr. Natalini has nothing to disclose.