Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain.
Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain.
J Intensive Care Med. 2023 Nov;38(11):1023-1041. doi: 10.1177/08850666231180165. Epub 2023 Jun 12.
The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated.
This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied.
A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; < .001), while it was 10.5% (131/1250) among patients without PM and PTX.
In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
评估了因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）而导致严重肺炎的患者发生气胸（PM）和/或气胸（PTX）的情况。
这是一项前瞻性观察性研究，在马德里（西班牙）的一家 COVID-19 专科学院的中级呼吸护理病房（IRCU）中对 2020 年 12 月 14 日至 2021 年 9 月 28 日期间入院的患者进行。所有患者均诊断为严重 SARS-CoV-2 肺炎，需要非侵入性呼吸支持（NIRS）：高流量鼻导管（HFNC）、持续气道正压通气（CPAP）和双水平气道正压通气（BiPAP）。研究了 PM 和/或 PTX 的发生率（总体和按 NIRS 分类）及其对有创机械通气（IMV）和死亡概率的影响。
共纳入 1306 例患者。4.3%（56/1306）发生 PM/PTX，3.8%（50/1306）发生 PM，1.6%（21/1306）发生 PTX，1.1%（15/1306）发生 PM+PTX。PM/PTX 患者中有 16.1%（9/56）单独使用 HFNC，而 83.9%（47/56）使用 HFNC+CPAP/BiPAP。相比之下，没有 PM 和 PTX 的患者中有 41.7%（521/1250）单独使用 HFNC（比值比[OR]0.27；95%置信区间[95%CI]0.13-0.55；<0.001），而 58.3%（729/1250）使用 HFNC+CPAP/BiPAP（OR 3.73；95%CI 1.81-7.68；<0.001）。PM/PTX 患者需要 IMV 的概率为 67.9%（36/53）（OR 7.46；95%CI 4.12-13.50；<0.001），而没有 PM 和 PTX 的患者为 22.1%（262/1185）。PM/PTX 患者的死亡率为 33.9%（19/56）（OR 4.39；95%CI 2.45-7.85；<0.001），而没有 PM 和 PTX 的患者为 10.5%（131/1250）。
在因需要 NIRS 而入住 IRCU 的严重 SARS-CoV-2 肺炎患者中，PM/PTX、PM、PTX 和 PM+PTX 的发生率分别为 4.3%、3.8%、1.6%和 1.1%。大多数 PM/PTX 患者使用 HFNC+CPAP/BiPAP 作为 NIRS 设备，比没有 PM 和 PTX 的患者多得多。PM/PTX 患者发生 IMV 和死亡的概率分别为 64.3%和 33.9%，高于没有 PM 和 PTX 的患者，分别为 21.0%和 10.5%。
