Kamil GONDEREN, Mehmet YILDIRIM, Fatma YILDIRIM, Meltem ŞİMŞEK

Barotravma Saptanan COVID-19 İlişkili ARDS Hastalarının Radyolojik Özellikleri ve Sonlanımları

Giriş: Spontan veya pozitif basınçlı ventilasyona bağlı gelişen barotravmanın Coronavirus 2019 (COVID-19) hastalarında diğer hastalara göre daha sık olduğu bildirilmiştir. Bu çalışmada yoğun bakım ünitesinde; invaziv mekanik ventilasyon (IMV), non-invaziv mekanik ventilasyon (NIMV) ya da yüksek akışlı nazal oksijen tedavisi (YANO) alan COVID-19 ilişkili ARDS hastalarında barotravma insidansının tespit edilmesi ve bu hastaların klinik, radyolojik özellikleri ve sonlanımlarının ortaya koyulması amaçlanmıştır. Gereç ve Yöntemler: Bu iki merkezli çalışmada, yoğun bakım ünitesinde COVID-19 ilişkili ARDS nedeniyle izlenen ve IMV, NIMV ve YANO tedavisi alan hastaların özellikleri ve sonlanımları retrospektif olarak araştırıldı. Barotravma bulguları pnomotoraks, pnomomediastinum, pnomoperikardiyum ve subkutan amfizem olarak belirlendi. Bulgular: Toplam 660 hastanın 29 (%4,4) tanesinde barotravma tespit edildi. Barotavma izlenen 29 hastanın 19 (%65,5) tanesinde pnömotoraks, 5 (%17,2) tanesinde pnömomediastinum ve 5 (%17,2) tanesinde subkutan amfizem mevcuttu. Onsekiz (%62,1) hastaya tedavi amaçlı tup torakostomi uygulanırken, 11 (%37,9) hasta konservatif izlendi. Barotravma saptandığı anda 17 (%58,6) hasta IMV, 11 (%37,9) hasta NIMV ve 1 (%3,4) hasta YANO almaktaydı. Barotravma izlenen 29 hastanın ortalama yoğun bakım yatış süresi 15,3±10,8 gün idi ve 19 (%65,5) hasta vefat etti. Sonuç: Barotravma, COVID-19 ilişkili ARDS hastalarında nadir olmayan ve yoğun bakım yatış süresi ve mortaliteyi artırabilecek bir durum olarak tespit edildi.

Anahtar Kelimeler:

COVID-19, ARDS, barotravma, yoğun bakım

Radiological Features and Outcomes of COVID-19 Associated ARDS Patients with Barotrauma

Objective: Barotrauma developing spontaneously or associated with positive pressure ventilation applied as respiratory support therapy is reported more frequently in patients with novel coronavirus 2019 (COVID-19). In this study, we aimed to determine the incidence of barotrauma in critically-ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS) who received invasive mechanical ventilation (IMV), (non-invasive mechanical ventilation NIMV) or high flow nasal oxygen therapy (HFNO) and reveal clinical features, radiological findings and outcomes of these patients. Materials and Methods: In this two-center study, the frequency and clinical characteristics of patients who developed barotrauma while being followed up in the ICU due to COVID-19 were retrospectively investigated. Results: Barotrauma was detected in 29 (4.4%) of 660 patients. Nineteen (65.5%) patients developed pneumothorax, 5 (17.2%) patients developed pneumomediastinum, 5 (17.2%) patients developed subcutaneous emphysema; 18 (62.1%) patients underwent tube thoracostomy, 11 (37.9%) patients were followed conservatively. When barotrauma developed, 17 (58.6%) patients were receiving IMV, 11 (37.9%) patients were receiving NIMV, and 1 (3.4%) patient was receiving HFNO. The mean length of stay in the ICU was 15.3±10.8 days, 19 (65.5%) of the patients died. Conclusion: Barotrauma is not uncommon in COVID-19 ARDS patients; It is a complication that can increase mortality and length of stay in ICU.

Keywords:

COVID-19, ARDS, barotrauma, intensive care unit,

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1. Ioannidis G, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015 Feb;7(Suppl 1):S38-43. doi: 10.3978/j.issn.2072-1439.2015.01.31.
2. Beitler JR, Malhotra A, Thompson BT. Ventilator-induced Lung Injury. Clin Chest Med. 2016 Dec;37(4):633-646. doi: 10.1016/j.ccm.2016.07.004. Epub 2016 Oct 14.
3. Lemmers DHL, Abu Hilal M, Bnà C, Prezioso C, Cavallo E, Nencini N, et al. Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty? ERJ Open Res. 2020 Nov 16;6(4):00385-2020.
4. Kangas-Dick A, Gazivoda V, Ibrahim M, Sun A, Shaw JP, Brichkov I, Wiesel O. Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia. J Laparoendosc Adv Surg Tech A. 2021 Mar;31(3):273-278.
5. Marsico S, Del Carpio Bellido LA, Zuccarino F. Spontaneous Pneumomediastinum and Macklin Effect in COVID-19 Patients. Arch Bronconeumol. 2021 Jan;57 Suppl 1:67.
6. Rajdev K, Spanel AJ, McMillan S, Lahan S, Boer B, Birge J, Thi M. Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation. J Intensive Care Med. 2021 Sep;36(9):1013-1017.
7. Kahn MR, Watson RL, Thetford JT, Wong JI, Kamangar N. High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019. J Intensive Care Med. 2021 Jun;36(6):646-654. doi: 10.1177/0885066621989959. Epub 2021 Mar 15.
8. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020 Apr;8(4):420-422. doi: 10.1016/S2213-2600(20)30076-X. Epub 2020 Feb 18. Erratum in: Lancet Respir Med. 2020 Feb 25
9. The ARDS Definition Task Force. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA. 2012;307(23):2526–2533.
10. Yıldırım F, Yıldız Gülhan P, Şimşek M. COVID-19 related acute respiratory distress syndrome: Pathological, radiological and clinical concordance. Tuberk Toraks. 2021 Sep;69(3):360-368.
11. Kacmarek RM, Villar J, Sulemanji D, Montiel R, Ferrando C, Blanco J, et al ; Open Lung Approach Network. Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial. Crit Care Med. 2016 Jan;44(1):32-42
12. McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, et al. Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 2020 Nov;297(2):E252-E262
13. Lien TC, Sung CS, Lee CH, Kao HK, Huang YC, Liu CY, et al. Characteristic features and outcomes of severe acute respiratory syndrome found in severe acute respiratory syndrome intensive care unit patients. J Crit Care 2008;23(4):557–564.
14. Das KM, Lee EY, Al Jawder SE, Enani MA, Singh R, Skakni L, et al. Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol 2015;205(3).
15. Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND, et al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J. 2020;56(5):2002697. 16. Elsaaran H, AlQinai S, AlTarrah D, Abdulrasoul M, Al-Youha S, Almazeedi S, et al. Prevalence and risk factors of barotrauma in Covid-19 patients admitted to an intensive care unit in Kuwait; a retrospective cohort study. Ann Med Surg (Lond). 2021;63:102141.
17. Edwards J-A, Breitman I, Bienstock J, Badami A, Kovatch I, Dresner L, Schwartzman A. Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: a case series. Ann Med Surg (Lond). 2021;61:24-29.
18. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: interpretation of the clinical literature in the light of laboratory experiment. Medicine. 1944;23:281–358.
19. Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography. World J Radiol. 2014 Nov 28;6(11):850-4.
20. Noppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121-7.
21. Martínez Chamorro E, Díez Tascón A, Ibáñez Sanz L, Ossaba Vélez S, Borruel Nacenta S. Radiologic diagnosis of patients with COVID-19. Radiologia (Engl Ed). 2021 Jan-Feb;63(1):56-73.
22. Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging 2020; 2: e200028
23. Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol 2020; 21: 541–544.
24. Liu K, Zeng Y, Xie P, Ye X, Xu G, Liu J, et al. . COVID-19 with cystic features on computed tomography: a case report. Medicine 2020; 99: e20175.
25. Cut TG, Tudoran C, Lazureanu VE, Marinescu AR, Dumache R, Tudoran M. Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection-A Series of Cases. J Clin Med. 2021 Mar 24;10(7):1346.