Cargando…
Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clari...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334538/ https://www.ncbi.nlm.nih.gov/pubmed/37430221 http://dx.doi.org/10.1186/s12890-023-02549-7 |
_version_ | 1785070877750067200 |
---|---|
author | Miyake, Nodoka Igarashi, Yutaka Nakae, Ryuta Mizobuchi, Taiki Masuno, Tomohiko Yokobori, Shoji |
author_facet | Miyake, Nodoka Igarashi, Yutaka Nakae, Ryuta Mizobuchi, Taiki Masuno, Tomohiko Yokobori, Shoji |
author_sort | Miyake, Nodoka |
collection | PubMed |
description | BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS. METHODS: This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group). RESULTS: Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmH(2)O (95% confidence interval [CI], 0.20–0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8–20.2] vs. 9.3 [7.3–10.2], respectively). For peak pressure, the median difference was -0.30 cmH(2)O (95% CI, -0.30 – -0.20) (20.4 [17.0–24.4] in the ALS group vs. 20.9 [16.7–24.6] in the non-ALS group). The mean pressure difference of 0.0 cmH(2)O (95% CI, 0.0–0.0) (12.7 [10.9–14.6] vs. 13.0 [10.3–15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70–0.72) (8.17 [6.79–9.54] vs. 7.43 [6.03–8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmH(2)O (95% CI, 12.76–21.95) (43.8 [28.2–68.8] vs. 35.7 [26.5–41.5], respectively); both were higher in the ALS group than in the non-ALS group. CONCLUSIONS: There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02549-7. |
format | Online Article Text |
id | pubmed-10334538 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-103345382023-07-12 Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study Miyake, Nodoka Igarashi, Yutaka Nakae, Ryuta Mizobuchi, Taiki Masuno, Tomohiko Yokobori, Shoji BMC Pulm Med Research BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS. METHODS: This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group). RESULTS: Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmH(2)O (95% confidence interval [CI], 0.20–0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8–20.2] vs. 9.3 [7.3–10.2], respectively). For peak pressure, the median difference was -0.30 cmH(2)O (95% CI, -0.30 – -0.20) (20.4 [17.0–24.4] in the ALS group vs. 20.9 [16.7–24.6] in the non-ALS group). The mean pressure difference of 0.0 cmH(2)O (95% CI, 0.0–0.0) (12.7 [10.9–14.6] vs. 13.0 [10.3–15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70–0.72) (8.17 [6.79–9.54] vs. 7.43 [6.03–8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmH(2)O (95% CI, 12.76–21.95) (43.8 [28.2–68.8] vs. 35.7 [26.5–41.5], respectively); both were higher in the ALS group than in the non-ALS group. CONCLUSIONS: There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02549-7. BioMed Central 2023-07-10 /pmc/articles/PMC10334538/ /pubmed/37430221 http://dx.doi.org/10.1186/s12890-023-02549-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Miyake, Nodoka Igarashi, Yutaka Nakae, Ryuta Mizobuchi, Taiki Masuno, Tomohiko Yokobori, Shoji Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title | Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title_full | Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title_fullStr | Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title_full_unstemmed | Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title_short | Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study |
title_sort | ventilator management and risk of air leak syndrome in patients with sars-cov-2 pneumonia: a single-center, retrospective, observational study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334538/ https://www.ncbi.nlm.nih.gov/pubmed/37430221 http://dx.doi.org/10.1186/s12890-023-02549-7 |
work_keys_str_mv | AT miyakenodoka ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy AT igarashiyutaka ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy AT nakaeryuta ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy AT mizobuchitaiki ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy AT masunotomohiko ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy AT yokoborishoji ventilatormanagementandriskofairleaksyndromeinpatientswithsarscov2pneumoniaasinglecenterretrospectiveobservationalstudy |