COVID-19 pneumonia and pneumothorax: case series

Barotrauma is a commonly reported complication in critically ill patients with ARDS caused by different etiologies, it’s rate is reported to be around %10. Pneumothorax/pneumomediastinum in COVID-19 patients seem to be more common and have different clinical characteristics. Here we report 9 patients who had pneumothorax and/or pneumomediastinum during their stay in the ICU.Patients who were admitted to ICU between March 2020 and December 2020, were reviewed for presence of pneumothorax, pneumomediastinum and subcutaneous emphysema during their ICU stay. Demographic charac-teristics, mechanical ventilation settings, documented ventilation parameters, outcomes were studied. A total of 161 patients were admitted to ICU during the study period, 96 were invasively ventilated. Nine patients had developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema during their admis-sion. Five of them were men and median age was 66.6 years. All patients were intubated and mechanically ventilated. All patients were managed conservatively. One patient was discharged from ICU, the others were lost due to other complications related to COVID-19. Upon detection of pneumothorax and/or mediastinum all patients were managed conservatively by limiting their PEEP and maximum inspiratory pressures and were followed by daily chest X-rays (CXR) for detection of any progress. None of the patients showed increase in size of their pneumothorax and/or pneumomediastinum. Hemodynamically instability due to pneumothorax and/or pneumomediastinum was not observed in any of the patients. Tension pneumothorax was not observed in any of the patients. Most common reason for death was sepsis due to secondary bacterial infec-tions.Acute deterioration with rapid oxygen desaturation or palpation of crepitation over thorax and neck in a COVID-19 patient should prompt a search for pneumothorax or pneumomediastinum. Conservative management may be an option as long as the patients are stable.

COVID-19 pnömonisi ve pnömotoraks: olgu serisi

Barotravma, kritik hastalarda farklı etiyolojilere bağlı ARDS tablosunda sık bildirilen bir komplikasyon olup, %10 oranında olduğu bildirilmektedir. COVID-19 hastalarında pnömotoraks/pnömomediastinum daha yaygın görülmektedir ve farklı klinik özelliklere sahip-tir. Burada, YBÜ’de kaldıkları süre boyunca pnömotoraks ve/veya pnömomediastinum gelişen 9 hastayı bildiriyoruz.Mart 2020 ile Aralık 2020 arasında YBÜ’de takip edilen hastalar, kaldıkları süre boyunca pnömotoraks, pnömomediastinum ve sub-kutan amfizem gelişmesi açısından incelendi. Demografik özellikleri, mekanik ventilasyon ayarları, kaydedilen ventilasyon parametre-leri, sağkalım durumları incelendi.Çalışma süresince YBÜ’ye toplam 161 hasta kabul edildi, 96 hastaya invaziv mekanik ventilasyon uygulandı. Dokuz hastada pnömo-toraks, pnömomediastinum ve/veya subkutan amfizem gelişti. Hastaların beşi erkekti ve ortanca yaş 66.6 yıldı. Tüm hastalar entübe edildi ve mekanik olarak havalandırıldı. Bir hasta YBÜ’den taburcu edildi, diğerleri COVID-19 ile ilgili diğer komplikasyonlar nedeniy-le kaybedildi. Pnömotoraks ve/veya pnömomediastenin saptanması üzerine, tüm hastalar, PEEP ve maksimum inspiratuar basınçları sınırlandırılarak konservatif olarak tedavi edildi ve herhangi bir ilerlemenin tespiti için günlük göğüs röntgenleri (CXR) çekilerek izlen-di. Hastaların hiçbirinde pnömotoraks ve/veya pnömomediastinum boyutlarında artış görülmedi. Hastaların hiçbirinde pnömotoraks ve/veya pnömomediastinuma bağlı hemodinamik instabilite gözlenmedi. Hiçbir hastada tansiyon pnömotoraks görülmedi. En yaygın ölüm nedeni, ikincil bakteriyel enfeksiyonlara bağlı sepsisti.COVID-19 hastasında hızlı oksijen desatürasyonu ile akut kötüleşme veya toraks ve boyunda krepitasyon palpasyonu; pnömotoraks veya pnömomediastinum araştırması yapılmasını gerektirmelidir. Konservatif tedavi, hastalar stabil olduğu sürece bir seçenek olabilir.

Kaynakça

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