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Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicente...

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Autores principales: Bonato, Matteo, Fraccaro, Alessia, Landini, Nicholas, Zanardi, Giuseppe, Catino, Cosimo, Savoia, Francesca, Malacchini, Nicola, Zeraj, Fabiola, Peditto, Piera, Catalanotti, Vito, Marcon, Elisabetta, Rossi, Emanuela, Pauletti, Alessia, Galvan, Silvia, Adami, Riccardo, Tiepolo, Marta, Salasnich, Mauro, Cuzzola, Maria, Zampieri, Francesca, Rattazzi, Marcello, Peta, Mario, Baraldo, Simonetta, Saetta, Marina, Morana, Giovanni, Romagnoli, Micaela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584854/
https://www.ncbi.nlm.nih.gov/pubmed/34768352
http://dx.doi.org/10.3390/jcm10214835
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author Bonato, Matteo
Fraccaro, Alessia
Landini, Nicholas
Zanardi, Giuseppe
Catino, Cosimo
Savoia, Francesca
Malacchini, Nicola
Zeraj, Fabiola
Peditto, Piera
Catalanotti, Vito
Marcon, Elisabetta
Rossi, Emanuela
Pauletti, Alessia
Galvan, Silvia
Adami, Riccardo
Tiepolo, Marta
Salasnich, Mauro
Cuzzola, Maria
Zampieri, Francesca
Rattazzi, Marcello
Peta, Mario
Baraldo, Simonetta
Saetta, Marina
Morana, Giovanni
Romagnoli, Micaela
author_facet Bonato, Matteo
Fraccaro, Alessia
Landini, Nicholas
Zanardi, Giuseppe
Catino, Cosimo
Savoia, Francesca
Malacchini, Nicola
Zeraj, Fabiola
Peditto, Piera
Catalanotti, Vito
Marcon, Elisabetta
Rossi, Emanuela
Pauletti, Alessia
Galvan, Silvia
Adami, Riccardo
Tiepolo, Marta
Salasnich, Mauro
Cuzzola, Maria
Zampieri, Francesca
Rattazzi, Marcello
Peta, Mario
Baraldo, Simonetta
Saetta, Marina
Morana, Giovanni
Romagnoli, Micaela
author_sort Bonato, Matteo
collection PubMed
description Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
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spelling pubmed-85848542021-11-12 Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy Bonato, Matteo Fraccaro, Alessia Landini, Nicholas Zanardi, Giuseppe Catino, Cosimo Savoia, Francesca Malacchini, Nicola Zeraj, Fabiola Peditto, Piera Catalanotti, Vito Marcon, Elisabetta Rossi, Emanuela Pauletti, Alessia Galvan, Silvia Adami, Riccardo Tiepolo, Marta Salasnich, Mauro Cuzzola, Maria Zampieri, Francesca Rattazzi, Marcello Peta, Mario Baraldo, Simonetta Saetta, Marina Morana, Giovanni Romagnoli, Micaela J Clin Med Article Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation. MDPI 2021-10-21 /pmc/articles/PMC8584854/ /pubmed/34768352 http://dx.doi.org/10.3390/jcm10214835 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bonato, Matteo
Fraccaro, Alessia
Landini, Nicholas
Zanardi, Giuseppe
Catino, Cosimo
Savoia, Francesca
Malacchini, Nicola
Zeraj, Fabiola
Peditto, Piera
Catalanotti, Vito
Marcon, Elisabetta
Rossi, Emanuela
Pauletti, Alessia
Galvan, Silvia
Adami, Riccardo
Tiepolo, Marta
Salasnich, Mauro
Cuzzola, Maria
Zampieri, Francesca
Rattazzi, Marcello
Peta, Mario
Baraldo, Simonetta
Saetta, Marina
Morana, Giovanni
Romagnoli, Micaela
Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title_full Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title_fullStr Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title_full_unstemmed Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title_short Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
title_sort pneumothorax and/or pneumomediastinum worsens the prognosis of covid-19 patients with severe acute respiratory failure: a multicenter retrospective case-control study in the north-east of italy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584854/
https://www.ncbi.nlm.nih.gov/pubmed/34768352
http://dx.doi.org/10.3390/jcm10214835
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