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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Veröffentlicht in:Journal of clinical medicine 2021-11, Vol.10 (23), p.5608
Hauptverfasser: 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
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container_issue 23
container_start_page 5608
container_title Journal of clinical medicine
container_volume 10
creator 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
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.
doi_str_mv 10.3390/jcm10235608
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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.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm10235608</identifier><identifier>PMID: 34884310</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Coronaviruses ; COVID-19 ; Emphysema ; Infectious diseases ; Observational studies ; Oxygen therapy ; Ventilators</subject><ispartof>Journal of clinical medicine, 2021-11, Vol.10 (23), p.5608</ispartof><rights>2021 by the authors. 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/). 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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.</description><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Emphysema</subject><subject>Infectious diseases</subject><subject>Observational studies</subject><subject>Oxygen therapy</subject><subject>Ventilators</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdUtFu0zAUjRCITWNP_IAlXpBQhx3HccIDUtUBq1TUiQ4knqJb-4a4SuxiO2V74x_4Jb6EL8FVKxj45R5dH59jH98se8roBec1fblRA6M5FyWtHmSnOZVyQnnFH97DJ9l5CBuaVlUVOZOPsxNeJMgZPc1-zq0yGq1C4lpybXEcXOych1sCVh8bA2oDIRo7DsRYUtSSzJaf5pcTVpNriAZtDOSbiR157zR6iPjr-48V7tAjmX64XBGXIAHyGcHvbWKH6ZzVOBj1ikwtWa4D-l1SchZ6soqjvtsbgSXzCL1J9aYzXpNF0uz_el-5sDWJ8CR71EIf8PxYz7KPb9_czK4mi-W7-Wy6mChelXFSaNHSVrNWAGgp2rVoCyHWDCnLsapRq6LAWilQGniZFyBTXKzAvFSt0LLlZ9nrg-52XKdMVHq3h77ZejOAv2scmObfHWu65ovbNVUpKklZEnh-FPDu64ghNoMJCvseLLoxNHn6RsGFlHWiPvuPunGjT_EcWCxnVO4FXxxYyrsQPLZ_LsNosx-Q5t6A8N8AgK6s</recordid><startdate>20211129</startdate><enddate>20211129</enddate><creator>Tetaj, Nardi</creator><creator>Garotto, Gabriele</creator><creator>Albarello, Fabrizio</creator><creator>Mastrobattista, Annelisa</creator><creator>Maritti, Micaela</creator><creator>Stazi, Giulia Valeria</creator><creator>Marini, Maria Cristina</creator><creator>Caravella, Ilaria</creator><creator>Macchione, Manuela</creator><creator>De Angelis, Giada</creator><creator>Busso, Donatella</creator><creator>Di Lorenzo, Rachele</creator><creator>Scarcia, Silvana</creator><creator>Farina, Anna</creator><creator>Centanni, Daniele</creator><creator>Vargas, Joel</creator><creator>Savino, Martina</creator><creator>Carucci, Alessandro</creator><creator>Antinori, Andrea</creator><creator>Palmieri, Fabrizio</creator><creator>D’Offizi, Gianpiero</creator><creator>Ianniello, Stefania</creator><creator>Taglietti, Fabrizio</creator><creator>Campioni, Paolo</creator><creator>Vaia, Francesco</creator><creator>Nicastri, Emanuele</creator><creator>Girardi, Enrico</creator><creator>Marchioni, Luisa</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8182-5896</orcidid><orcidid>https://orcid.org/0000-0001-6566-9838</orcidid><orcidid>https://orcid.org/0000-0001-8184-6291</orcidid><orcidid>https://orcid.org/0000-0002-7275-7358</orcidid><orcidid>https://orcid.org/0000-0002-2906-4855</orcidid><orcidid>https://orcid.org/0000-0001-5115-709X</orcidid><orcidid>https://orcid.org/0000-0003-0606-6353</orcidid><orcidid>https://orcid.org/0000-0002-5606-8712</orcidid></search><sort><creationdate>20211129</creationdate><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><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></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-4d5f0fd1f5aad75fb5f455b1e012e89edc44e9ccacda3624a742114e26cf5d7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Emphysema</topic><topic>Infectious diseases</topic><topic>Observational studies</topic><topic>Oxygen therapy</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tetaj, Nardi</creatorcontrib><creatorcontrib>Garotto, Gabriele</creatorcontrib><creatorcontrib>Albarello, Fabrizio</creatorcontrib><creatorcontrib>Mastrobattista, Annelisa</creatorcontrib><creatorcontrib>Maritti, Micaela</creatorcontrib><creatorcontrib>Stazi, Giulia Valeria</creatorcontrib><creatorcontrib>Marini, Maria Cristina</creatorcontrib><creatorcontrib>Caravella, Ilaria</creatorcontrib><creatorcontrib>Macchione, Manuela</creatorcontrib><creatorcontrib>De Angelis, Giada</creatorcontrib><creatorcontrib>Busso, Donatella</creatorcontrib><creatorcontrib>Di Lorenzo, Rachele</creatorcontrib><creatorcontrib>Scarcia, Silvana</creatorcontrib><creatorcontrib>Farina, Anna</creatorcontrib><creatorcontrib>Centanni, Daniele</creatorcontrib><creatorcontrib>Vargas, Joel</creatorcontrib><creatorcontrib>Savino, Martina</creatorcontrib><creatorcontrib>Carucci, Alessandro</creatorcontrib><creatorcontrib>Antinori, Andrea</creatorcontrib><creatorcontrib>Palmieri, Fabrizio</creatorcontrib><creatorcontrib>D’Offizi, Gianpiero</creatorcontrib><creatorcontrib>Ianniello, Stefania</creatorcontrib><creatorcontrib>Taglietti, Fabrizio</creatorcontrib><creatorcontrib>Campioni, Paolo</creatorcontrib><creatorcontrib>Vaia, Francesco</creatorcontrib><creatorcontrib>Nicastri, Emanuele</creatorcontrib><creatorcontrib>Girardi, Enrico</creatorcontrib><creatorcontrib>Marchioni, Luisa</creatorcontrib><creatorcontrib>ICU COVID-19 Study Group</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tetaj, Nardi</au><au>Garotto, Gabriele</au><au>Albarello, Fabrizio</au><au>Mastrobattista, Annelisa</au><au>Maritti, Micaela</au><au>Stazi, Giulia Valeria</au><au>Marini, Maria Cristina</au><au>Caravella, Ilaria</au><au>Macchione, Manuela</au><au>De Angelis, Giada</au><au>Busso, Donatella</au><au>Di Lorenzo, Rachele</au><au>Scarcia, Silvana</au><au>Farina, Anna</au><au>Centanni, Daniele</au><au>Vargas, Joel</au><au>Savino, Martina</au><au>Carucci, Alessandro</au><au>Antinori, Andrea</au><au>Palmieri, Fabrizio</au><au>D’Offizi, Gianpiero</au><au>Ianniello, Stefania</au><au>Taglietti, Fabrizio</au><au>Campioni, Paolo</au><au>Vaia, Francesco</au><au>Nicastri, Emanuele</au><au>Girardi, Enrico</au><au>Marchioni, Luisa</au><aucorp>ICU COVID-19 Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Journal of clinical medicine</jtitle><date>2021-11-29</date><risdate>2021</risdate><volume>10</volume><issue>23</issue><spage>5608</spage><pages>5608-</pages><issn>2077-0383</issn><eissn>2077-0383</eissn><abstract>(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.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34884310</pmid><doi>10.3390/jcm10235608</doi><orcidid>https://orcid.org/0000-0001-8182-5896</orcidid><orcidid>https://orcid.org/0000-0001-6566-9838</orcidid><orcidid>https://orcid.org/0000-0001-8184-6291</orcidid><orcidid>https://orcid.org/0000-0002-7275-7358</orcidid><orcidid>https://orcid.org/0000-0002-2906-4855</orcidid><orcidid>https://orcid.org/0000-0001-5115-709X</orcidid><orcidid>https://orcid.org/0000-0003-0606-6353</orcidid><orcidid>https://orcid.org/0000-0002-5606-8712</orcidid><oa>free_for_read</oa></addata></record>
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source Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central
subjects Coronaviruses
COVID-19
Emphysema
Infectious diseases
Observational studies
Oxygen therapy
Ventilators
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
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