COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam.
Department of Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam.
J Cardiothorac Surg. 2022 Aug 24;17(1):202. doi: 10.1186/s13019-022-01966-9.
Tension pneumomediastinum is one of the most serious complications in COVID-19 patients with respiratory distress requiring invasive mechanical ventilation. This complication can lead to rapid hemodynamic instability and death if it is not recognized in a timely manner and intervenes promptly.
We reported 7 COVID-19 patients with tension pneumomediastinum at a field hospital. All patients were critically ill with ARDS. These 7 patients, including 3 females and 4 males in this series, were aged between 39 and 70 years. Tension pneumomediastinum occurred on the first day of mechanical ventilation in 3 patients and later in the course of hospital stay, even 10 days after being intubated and ventilated. The tension pneumomediastinum caused hemodynamic instability and worsened respiratory mechanics with imminent cardiopulmonary collapse. In this series, we used two surgical techniques: (i) mediastinal decompression by suprasternal drainage with or without simultaneous pleural drainage in the first two cases and (ii) mediastinal drainage via suprasternal and subxiphoid incisions in 5 patients. The surgical procedures were feasible and reversed the pending cardiopulmonary collapse. Four patients had a favorable postprocedural period and were discharged from the intensive care center. Both patients undergoing suprasternal drainage died of failed/recurrent tension pneumomediastinum and nosocomial infection. Only one in five patients who underwent mediastinal drainage via suprasternal and subxiphoid incisions died of septic shock secondary to ventilator-associated pneumonia.
Tension pneumomediastinum was a life-threatening complication in critically ill COVID-19 patients requiring mechanical ventilation. Surgical mediastinal decompression was the salvage procedure. The surgical technique of mediastinal drainage via suprasternal and subxiphoid incisions proved an advantage in tension relief, hemodynamic improvement and mortality reduction.
张力性气胸是 COVID-19 患者呼吸窘迫需要有创机械通气的最严重并发症之一。如果不能及时识别并及时干预，这种并发症会导致迅速发生血流动力学不稳定和死亡。
我们在一家野战医院报告了 7 例 COVID-19 张力性气胸患者。所有患者均患有 ARDS，病情危重。这 7 例患者均为女性 3 例，男性 4 例，年龄在 39 至 70 岁之间。3 例患者在机械通气的第一天发生张力性气胸，在住院期间的后期，甚至在插管和通气 10 天后发生。张力性气胸导致血流动力学不稳定，呼吸力学恶化，心肺崩溃迫在眉睫。在本系列中，我们使用了两种手术技术：（i）胸骨上引流联合或不联合同期胸腔引流治疗前 2 例患者的纵隔减压，以及（ii）胸骨上和剑突下切口联合纵隔引流治疗 5 例患者。手术过程可行，逆转了即将发生的心肺崩溃。4 例患者术后恢复良好，从重症监护中心出院。行胸骨上引流的 2 例患者均因张力性气胸复发和医院获得性感染死亡。仅 5 例行胸骨上和剑突下切口纵隔引流的患者中有 1 例死于呼吸机相关性肺炎引起的感染性休克。
张力性气胸是需要机械通气的危重症 COVID-19 患者的致命并发症。外科纵隔减压是挽救生命的方法。胸骨上和剑突下切口联合纵隔引流术在缓解张力、改善血流动力学和降低死亡率方面具有优势。
