Sethi S M, Ahmed A S, Hanif S, Aqeel M, Zubairi A B S
Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Epidemiol Infect. 2021 Jan 20;149:e37. doi: 10.1017/S095026882100011X.
Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.
自2019年12月以来，新型冠状病毒肺炎（COVID-19）的临床症状及其并发症一直在演变。随着需要正压通气的COVID患者数量不断增加，皮下气肿（SE）的发生率也在上升。我们报告了10例患有SE和气纵隔的COVID-19患者。患者的平均年龄为59±8岁（范围23-75岁）。其中大多数为男性（80%），常见症状为呼吸困难（100%）、发热（80%）和咳嗽（80%）。他们均无潜在肺部疾病。所有患者入院时均患有急性呼吸窘迫综合征，动脉血氧分压/吸入氧分数值（PaO2/FiO2）中位数为122.5。十名患者中有八名在急诊科初次胸部X线检查时出现自发性气纵隔。SE发生前辅助通气的中位持续时间为5.5天（四分位间距5-10天）。接受有创机械通气的患者呼气末正压（PEEP）最高为10 cmH2O，而在无创通气时发生皮下气肿的患者平均PEEP为8 cmH2O。所有患者均接受了皮质类固醇治疗，其中六名患者还接受了托珠单抗治疗，七名患者分别接受了恢复期血浆治疗。七名患者在住院期间死亡。所有患者（无论存活与否）住院时间均延长，平均为14天（范围8-25天）。我们的研究结果表明，由于COVID-19引发的炎症反应导致肺部损伤，进而因使用正压通气引发了这一并发症。我们得出结论，对于重症COVID-19急性呼吸窘迫综合征患者，无论何时出现自发性气纵隔和SE，均与不良预后相关。
