Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
Artif Organs. 2024 Sep;48(9):1038-1048. doi: 10.1111/aor.14760. Epub 2024 Apr 25.
Patients with severe respiratory failure due to COVID-19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V-V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID-19 and acute respiratory failure due to spontaneous PM.
This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID-19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V-V ECMO support (V-V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission.
Twenty-two patients were included in this study (invasive ventilation group: 13 [59%]; V-V ECMO group: 9 [41%]). The V-V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12-0.97], p = 0.04). Five (38%) patients in the V-V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V-V ECMO support within 30 days from ICU admission. Three (33%) patients in the V-V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48-45.3], p = 0.18).
Preliminary data suggest that V-V ECMO without invasive ventilation may improve survival in COVID-19-related acute respiratory failure due to spontaneous PM. The study's retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution.
因 COVID-19 导致严重呼吸衰竭但未行机械通气的患者，并发自发性纵隔气肿时可能会发生严重低氧血症。这些患者可能会因有创通气而受到伤害。或者，可以应用静脉-静脉（V-V）体外膜肺氧合（ECMO）。我们报告了 V-V ECMO 和有创通气作为 COVID-19 患者和自发性 PM 导致的急性呼吸衰竭的初始高级呼吸支持的疗效。
这是一项回顾性队列研究，于 2020 年 3 月至 2022 年 1 月进行。入组患者患有 COVID-19 和自发性 PM 导致的急性呼吸衰竭，且未行有创通气。患者在重症监护病房（ICU）中接受治疗，主要治疗选择为有创通气（有创通气组）或 V-V ECMO 支持（V-V ECMO 组）。主要结局为 ICU 入住后 90 天的死亡率和 ICU 出院率。
本研究共纳入 22 例患者（有创通气组：13 例[59%]；V-V ECMO 组：9 例[41%]）。V-V ECMO 策略与较低的死亡率显著相关（风险比[HR]0.33[95%CI 0.12-0.97]，p=0.04）。V-V ECMO 组中有 5（38%）例患者需要气管插管，而有创通气组中有 8（89%）例患者在 ICU 入住后 30 天内需要 V-V ECMO 支持。V-V ECMO 组中有 3（33%）例患者在 90 天内从 ICU 出院，而有创通气组中只有 1（8%）例患者（HR 4.71[95%CI 0.48-45.3]，p=0.18）。
初步数据表明，无有创通气的 V-V ECMO 可能改善 COVID-19 相关自发性 PM 导致的急性呼吸衰竭的生存率。研究的回顾性设计和有限的样本量突出了进一步研究的必要性，并需谨慎对待。
