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Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital

(1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). However, the incidence and the...

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Autores principales: Tetaj, Nardi, Garotto, Gabriele, Albarello, Fabrizio, Mastrobattista, Annelisa, Maritti, Micaela, Stazi, Giulia Valeria, Marini, Maria Cristina, Caravella, Ilaria, Macchione, Manuela, De Angelis, Giada, Busso, Donatella, Di Lorenzo, Rachele, Scarcia, Silvana, Farina, Anna, Centanni, Daniele, Vargas, Joel, Savino, Martina, Carucci, Alessandro, Antinori, Andrea, Palmieri, Fabrizio, D’Offizi, Gianpiero, Ianniello, Stefania, Taglietti, Fabrizio, Campioni, Paolo, Vaia, Francesco, Nicastri, Emanuele, Girardi, Enrico, Marchioni, Luisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658701/
https://www.ncbi.nlm.nih.gov/pubmed/34884310
http://dx.doi.org/10.3390/jcm10235608
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author Tetaj, Nardi
Garotto, Gabriele
Albarello, Fabrizio
Mastrobattista, Annelisa
Maritti, Micaela
Stazi, Giulia Valeria
Marini, Maria Cristina
Caravella, Ilaria
Macchione, Manuela
De Angelis, Giada
Busso, Donatella
Di Lorenzo, Rachele
Scarcia, Silvana
Farina, Anna
Centanni, Daniele
Vargas, Joel
Savino, Martina
Carucci, Alessandro
Antinori, Andrea
Palmieri, Fabrizio
D’Offizi, Gianpiero
Ianniello, Stefania
Taglietti, Fabrizio
Campioni, Paolo
Vaia, Francesco
Nicastri, Emanuele
Girardi, Enrico
Marchioni, Luisa
author_facet Tetaj, Nardi
Garotto, Gabriele
Albarello, Fabrizio
Mastrobattista, Annelisa
Maritti, Micaela
Stazi, Giulia Valeria
Marini, Maria Cristina
Caravella, Ilaria
Macchione, Manuela
De Angelis, Giada
Busso, Donatella
Di Lorenzo, Rachele
Scarcia, Silvana
Farina, Anna
Centanni, Daniele
Vargas, Joel
Savino, Martina
Carucci, Alessandro
Antinori, Andrea
Palmieri, Fabrizio
D’Offizi, Gianpiero
Ianniello, Stefania
Taglietti, Fabrizio
Campioni, Paolo
Vaia, Francesco
Nicastri, Emanuele
Girardi, Enrico
Marchioni, Luisa
author_sort Tetaj, Nardi
collection PubMed
description (1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). However, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate–severe ARDS hospitalized in a year of the pandemic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate–severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate–severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of barotrauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate–severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate–severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation.
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spelling pubmed-86587012021-12-10 Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital Tetaj, Nardi Garotto, Gabriele Albarello, Fabrizio Mastrobattista, Annelisa Maritti, Micaela Stazi, Giulia Valeria Marini, Maria Cristina Caravella, Ilaria Macchione, Manuela De Angelis, Giada Busso, Donatella Di Lorenzo, Rachele Scarcia, Silvana Farina, Anna Centanni, Daniele Vargas, Joel Savino, Martina Carucci, Alessandro Antinori, Andrea Palmieri, Fabrizio D’Offizi, Gianpiero Ianniello, Stefania Taglietti, Fabrizio Campioni, Paolo Vaia, Francesco Nicastri, Emanuele Girardi, Enrico Marchioni, Luisa J Clin Med Article (1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). However, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate–severe ARDS hospitalized in a year of the pandemic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate–severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate–severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of barotrauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate–severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate–severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation. MDPI 2021-11-29 /pmc/articles/PMC8658701/ /pubmed/34884310 http://dx.doi.org/10.3390/jcm10235608 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
Tetaj, Nardi
Garotto, Gabriele
Albarello, Fabrizio
Mastrobattista, Annelisa
Maritti, Micaela
Stazi, Giulia Valeria
Marini, Maria Cristina
Caravella, Ilaria
Macchione, Manuela
De Angelis, Giada
Busso, Donatella
Di Lorenzo, Rachele
Scarcia, Silvana
Farina, Anna
Centanni, Daniele
Vargas, Joel
Savino, Martina
Carucci, Alessandro
Antinori, Andrea
Palmieri, Fabrizio
D’Offizi, Gianpiero
Ianniello, Stefania
Taglietti, Fabrizio
Campioni, Paolo
Vaia, Francesco
Nicastri, Emanuele
Girardi, Enrico
Marchioni, Luisa
Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title_full Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title_fullStr Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title_full_unstemmed Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title_short Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital
title_sort incidence of pneumothorax and pneumomediastinum in 497 covid-19 patients with moderate–severe ards over a year of the pandemic: an observational study in an italian third level covid-19 hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658701/
https://www.ncbi.nlm.nih.gov/pubmed/34884310
http://dx.doi.org/10.3390/jcm10235608
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