Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK.
BMJ Case Rep. 2021 Mar 23;14(3):e241809. doi: 10.1136/bcr-2021-241809.
SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.
SARS-CoV-2 导致了大流行 COVID-19，它迅速传播，使医疗保健系统不堪重负。无创正压通气（NIV）可作为桥接治疗，以延迟有创机械通气，或作为独立治疗。自发性纵隔气肿罕见且自限性，但在 COVID-19 中记录到发病率增加。在此，我们记录了两例与纵隔气肿相关的严重 COVID-19 患者的 NIV 治疗延长病例。患者 1 为 64 岁男性，在撤机后接受 NIV 治疗时出现症状并存活下来。患者 2 为 82 岁女性，尽管接受了 NIV 治疗，但病情仍未见改善，经检查发现纵隔气肿。经审查，该患者接受了最佳支持治疗，3 天后死亡。我们强调了在接受 NIV 治疗的严重 COVID-19 患者中，识别不太常见的恶化原因的重要性。此外，这些情况下的纵隔气肿并不总是导致不良结局。
