Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit
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Published:2023-06-12
Issue:11
Volume:38
Page:1023-1041
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ISSN:0885-0666
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Container-title:Journal of Intensive Care Medicine
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language:en
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Short-container-title:J Intensive Care Med
Author:
Lorente-González Miguel1ORCID, Terán-Tinedo José Rafael1, Zevallos-Villegas Annette1, Laorden Daniel1, Mariscal-Aguilar Pablo1, Suárez-Ortiz Miguel1, Cano-Sanz Eduardo2, Ortega-Fraile María Ángeles2, Hernández-Núñez Joaquín2ORCID, Falcone Adalgisa1, Saiz-Lou Elena María3, Plaza-Moreno María Cristina1, García-Fadul Christian1, Valle-Falcones Manuel1, Sánchez-Azofra Ana1, Funes-Moreno Clotilde4, De-La-Calle-Gil Isabel4, Navarro-Casado Rosalía4, Carballo-López Daniel4, Gholamian-Ovejero Soraya4, Gallego-Rodríguez Berta4, Villén-Villegas Tomás2, Landete Pedro15
Affiliation:
1. Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain 2. Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain 3. Department of Internal Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain 4. Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain 5. Faculty of Medicine, Universidad Autónoma de Madrid [Autónoma University of Madrid], Madrid, Madrid, Spain
Abstract
Introduction The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. Methods This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. Results A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM/PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM/PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM/PTX. Conclusions In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM/PTX. The probabilities of IMV and death among patients with PM/PTX were 67.9% and 33.9%, respectively, higher than those observed in patients without PM/PTX, which were 22.1% and 10.5%, respectively.
Publisher
SAGE Publications
Subject
Critical Care and Intensive Care Medicine
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