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10.1053/j.jvca.2021.02.008

http://scihub22266oqcxt.onion/10.1053/j.jvca.2021.02.008
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suck abstract from ncbi

pmid33678544      J+Cardiothorac+Vasc+Anesth 2021 ; 35 (12): 3642-3651
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  • Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients #MMPMID33678544
  • Belletti A; Palumbo D; Zangrillo A; Fominskiy EV; Franchini S; Dell'Acqua A; Marinosci A; Monti G; Vitali G; Colombo S; Guazzarotti G; Lembo R; Maimeri N; Faustini C; Pennella R; Mushtaq J; Landoni G; Scandroglio AM; Dagna L; De Cobelli F
  • J Cardiothorac Vasc Anesth 2021[Dec]; 35 (12): 3642-3651 PMID33678544show ga
  • OBJECTIVE: To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN: Observational study. SETTING: Tertiary-care university hospital. PARTICIPANTS: One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. INTERVENTIONS: The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. MEASUREMENTS AND MAIN RESULTS: PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 +/- 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 +/- 13.4 v 18.7 +/- 9.8 in patients without PNX/PMD, p?=?0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p?=?0.04). CONCLUSION: PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.
  • |*COVID-19[MESH]
  • |*Mediastinal Emphysema/diagnostic imaging/epidemiology[MESH]
  • |*Pneumothorax/diagnostic imaging/epidemiology/etiology[MESH]
  • |Humans[MESH]
  • |Respiration, Artificial/adverse effects[MESH]


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