Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
BMC Pulm Med. 2023 Jul 10;23(1):251. doi: 10.1186/s12890-023-02549-7.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS.
This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group).
Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmHO (95% confidence interval [CI], 0.20-0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8-20.2] vs. 9.3 [7.3-10.2], respectively). For peak pressure, the median difference was -0.30 cmHO (95% CI, -0.30 - -0.20) (20.4 [17.0-24.4] in the ALS group vs. 20.9 [16.7-24.6] in the non-ALS group). The mean pressure difference of 0.0 cmHO (95% CI, 0.0-0.0) (12.7 [10.9-14.6] vs. 13.0 [10.3-15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70-0.72) (8.17 [6.79-9.54] vs. 7.43 [6.03-8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmHO (95% CI, 12.76-21.95) (43.8 [28.2-68.8] vs. 35.7 [26.5-41.5], respectively); both were higher in the ALS group than in the non-ALS group.
There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development.
据报道，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）肺炎与空气泄漏综合征（ALS）有关，包括纵隔气肿和气胸，死亡率很高。在这项研究中，我们比较了每分钟从呼吸机中获得的值，以阐明呼吸机管理与发生 ALS 的风险之间的关系。
这项单中心、回顾性、观察性研究在日本东京的一家三级护理医院进行，时间为 21 个月。从 SARS-CoV-2 肺炎患者的呼吸机管理中收集了患者背景、呼吸机数据和结局的信息。在呼吸机管理开始后 30 天内发生 ALS 的患者（ALS 组）与未发生 ALS 的患者（非 ALS 组）进行了比较。
在 105 名患者中，有 14 名（13%）发生了 ALS。中位呼气末正压（PEEP）差值为 0.20 cmHO（95%置信区间 [CI]，0.20-0.20），且在 ALS 组高于非 ALS 组（9.6 [7.8-20.2] vs. 9.3 [7.3-10.2]）。对于峰压，中位差值为 -0.30 cmHO（95%CI，-0.30 - -0.20）（20.4 [17.0-24.4]在 ALS 组 vs. 20.9 [16.7-24.6]在非 ALS 组）。0.0 cmHO（95%CI，0.0-0.0）（12.7 [10.9-14.6] vs. 13.0 [10.3-15.0]）的平均压力差也在非 ALS 组中高于 ALS 组。每理想体重的单次通气量差异为 0.71 mL/kg（95%CI，0.70-0.72）（8.17 [6.79-9.54] vs. 7.43 [6.03-8.81]），动态肺顺应性差异为 8.27 mL/cmHO（95%CI，12.76-21.95）（43.8 [28.2-68.8] vs. 35.7 [26.5-41.5]）；两组均高于非 ALS 组。
较高的呼吸机压力与 ALS 的发生之间没有关联。ALS 组的动态肺顺应性和潮气量高于非 ALS 组，这可能表明 ALS 与肺部有关。限制潮气量的呼吸机管理可能有助于预防 ALS 的发生。
