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Cardenas J, Cardenas JM, Garber M, Irazuzta J. Incidence of Air Leak Syndrome in Pediatric Patients With SARS-COV-2 Pneumonia and Respiratory Failure: A Single-Center Retrospective Study. Cureus 2023; 15:e43329. [PMID: 37700955 PMCID: PMC10493069 DOI: 10.7759/cureus.43329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Air leak syndrome (ALS) is defined as the extrusion of air from an aerated compartment into an unaerated compartment with associated symptoms of respiratory distress. This syndrome can occur as a consequence of trauma, iatrogenic causes, or spontaneously. Retrospective investigations conducted in the adult population have demonstrated an elevated risk of spontaneous ALS development in patients with coronavirus disease 2019 (COVID-19) pneumonia, along with its correlation with mortality. However, no studies have yet explored this phenomenon within the pediatric population. In light of this knowledge gap, we conducted a retrospective chart review comprising 128 pediatric patients ranging in age from one month to 18 years. The primary objective was to assess the incidence of ALS in two distinct groups: patients diagnosed with COVID-19 pneumonia and those with non-COVID-19 viral pneumonia. The groups were compared using Fisher's exact test for sex, the presence of ALS, the requirement of extracorporeal membrane oxygenation (ECMO), and death. The modified Wald method was used to calculate the 95% confidence interval for the mortality rate in patients with COVID-19 pneumonia in the presence of ALS. Our findings revealed a higher prevalence of ALS in patients with COVID-19 pneumonia compared to the non-COVID-19 viral pneumonia group, with a statistically significant P-value of 0.02 and an odds ratio (OR) of 6.72. In terms of mortality rates, there was a statistically significant difference between the two groups (P = 0.025, OR = 1.083). In addition, in patients with ALS in the presence of COVID-19 pneumonia, the mortality rate was 37.5%. However, the requirement of ECMO was not statistically significant (P = 0.16, OR = 1.04). These results suggest that patients with COVID-19 pneumonia have an increased mortality rate and a heightened risk of developing ALS compared to individuals with other viral pneumonias. Furthermore, the presence of ALS was associated with a high mortality rate in COVID-19 pneumonia patients. However, it is crucial to note that obtaining a larger patient sample and involving multiple institutions would be necessary to obtain more consistent and robust data.
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Affiliation(s)
- Juan Cardenas
- Pediatric Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jose M Cardenas
- Pediatric Critical Care, University of Florida College of Medicine, Gainesville, USA
| | - Matthew Garber
- Hospital Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jose Irazuzta
- Pediatric Critical Care, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Ramos PV, Oliveira AM, Simas Â, Rocha Vera Cruz M. COVID-19: A Possible Cause of Spontaneous Pneumoperitoneum. J Crit Care Med (Targu Mures) 2023; 9:192-197. [PMID: 37588186 PMCID: PMC10425923 DOI: 10.2478/jccm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/10/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Pneumoperitoneum is the presence of air within the peritoneal cavity and is mostly caused by organ rupture. Spontaneous pneumoperitoneum accounts 5% to 15% of the cases and occurs in the absence of organ damage. The pulmonary origin of pneumoperitoneum is unusual, and probably associated with mechanical ventilation and alveolar leak. In patients with coronavirus disease 2019 (COVID-19) there are some reports of air leak, like pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema. Case presentation We present the case of a 70-year-old man with COVID-19 pneumonia admitted to the Intensive Care Unit (ICU). Since admission he was on Non-Invasive Ventilation (NIV), without improvement, needing Invasive Mechanical Ventilation (IMV) due to severe respiratory failure. Five days after IMV despite protective lung ventilation, massive spontaneous subcutaneous emphysema, pneumomediastinum and pneumoperitoneum were diagnosed. Besides initial conservative management 12 hours later, the patient developed abdominal compartment syndrome requiring percutaneous needle decompression. Conclusions Pneumoperitoneum can be considered a rare complication of COVID-19 pneumonia and its management, resulting not only from the viral pulmonary but also from secondary causes. Conservative management should be usually enough. However, in the presence of abdominal compartment syndrome prompt recognition and treatment are crucial and eventually lifesaving.
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Affiliation(s)
| | - Ana Maria Oliveira
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Ângela Simas
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
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Hung SW, Liao YC, Chi IC, Lin TY, Lin YC, Lin HJ, Huang ST. Integrated Chinese herbal medicine and Western medicine successfully resolves spontaneous subcutaneous emphysema and pneumomediastinum in a patient with severe COVID-19 in Taiwan: A case report. Explore (NY) 2023; 19:147-152. [PMID: 34955379 PMCID: PMC8667518 DOI: 10.1016/j.explore.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023]
Abstract
CASE Serious complications of severe coronavirus disease 2019 (COVID-19) include subcutaneous emphysema (SE) and pneumomediastinum, which are complicated to treat with conventional Western medicine. We report how combining Chinese herbal medicine (CHM) with Western medicine quickly resolved a patient's COVID-19-associated pulmonary complications, shortened hospital stay and improved quality of life. CLINICAL FEATURES AND OUTCOME A 59-year-old male with a history of smoking and tumors was diagnosed with COVID-19 in May 2021. At hospitalization, his oxygen saturation (SpO2) was 80%, he had a continuous severe cough, rapid shallow breathing, spontaneous SE and pneumomediastinum. By Day 4 of hospitalization, his condition was worsening despite standard care, so CHM was added. After 3-5 days, his coughing had lessened and supplementary oxygen therapy was de-escalated. Nine days after starting CHM, the SE had completely resolved and the patient avoided intubation. His WHO OS 10-point Scale score had fallen from 6 to 3 points and the modified Medical Research Council Dyspnea Scale score from 4 to 2 points. He was hospitalized for 19 days. At 1 week post-discharge, the patient could handle most of his daily activities and experienced minor shortness of breath only when performing labor-intensive tasks. At 1 month, his work output was restored to pre-COVID-19 levels. CONCLUSION CHM combined with standard Western medicine improved pulmonary function, respiratory rate, blood oxygen saturation and shortened the hospital stay of a patient with severe COVID-19 complicated by SE and pneumomediastinum.
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Affiliation(s)
- Shuo-Wen Hung
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Yuan-Ching Liao
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan
| | - I-Chang Chi
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Ting-Yen Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Department of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Department of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan; Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; An-Nan Hospital, China Medical University, No. 66, Section 2, Zhanghe Road, Annan District, Tainan City 709, Taiwan.
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Juneja D, Goel A, Singh O, Kataria S, Gupta A, Singh A. Air leak in post COVID-19 patients: Incidence, ICU course and outcomes. Med Intensiva 2022; 46:648-650. [PMID: 36344014 PMCID: PMC9633922 DOI: 10.1016/j.medine.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022]
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DİREK T, İNAN K, ŞENGÜL İNAN M, ŞAHİN MF, AYTEKİN ÇELİK İ, KARAOGLANOGLU N. Analysis of the factors that affect survival among patients who developed subcutaneous emphysema monitored on COVID-19 diagnosis: single-centred research. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1146541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The COVID-19 patients with pulmonary involvement frequently develop pneumothorax, pneumomediastinum and subcutaneous emphysema due to barotrauma. Reviewing the literature, pneumothorax, pneumomediastinum and subcutaneous emphysema it can be observed among ICU patients due to the pulmonary involvement of the COVID-19 disease, and therefore, can cause mortality and morbidity. This study aims to analyse the factors that affect mortality in COVID-19 patients in ICUs who develop subcutaneous emphysema.
Material and Method: A total of 854 COVID-19 patients who were consulted from all branches in the Chest Surgery Clinic of Ankara City Hospital between September 1, 2020 - March 1, 2021 were retrospectively analyzed. Demographic characteristics, comorbid diseases and COVID-related tests (LDH, D-dimer, procalcitonin, ferritin, CRP, IL-6, lymphocyte percentage and neutrophil and lymphocyte ratio) imaging results and survival of 66 patients with subcutaneous emphysema were analyzed.
Results: Of the patients, 41 (62%) were male and 25 (38%) were female. The mean age was 63 years. 55 (83%) of these patients were followed up with invasive ventilation support due to general health impairment, increased oxygen demand and heart problems. Age, intubation and NLR were found to be statistically significant in terms of survival and death, on survival. It was discovered that age and intubation variables could be risk factors. The mortality rates were 1.01 times higher for the elderly compared to the younger patients and 13.8 times higher for the intubated compared to the non-intubated patients.
Conclusion: Age of patient and intubation can be regarded as risk factors for mortality in COVID-19 patients with subcutaneous emphysema, monitored in ICUs. Furthermore, comorbid diseases increase mortality rates.
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Juneja D, Kataria S, Singh O. Air leaks in COVID-19. World J Virol 2022; 11:176-185. [PMID: 36159609 PMCID: PMC9372787 DOI: 10.5501/wjv.v11.i4.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/11/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to create havoc and may present with myriad complications involving many organ systems. However, the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected. There is a high incidence of air leaks in patients with COVID-19, leading to acute worsening of clinical condition. The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and un-derlying lung disease. The exact pathophysiology of air leaks with COVID-19 remains unclear, but multiple factors may play a role in their development. A significant proportion of air leaks may be asymptomatic; hence, a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality. These air leaks may even develop weeks to months after the disease onset, leading to acute deterioration in the post-COVID period. Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Sahil Kataria
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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Singh A, Singh Y, Pangasa N, Khanna P, Trikha A. Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review. Indian J Crit Care Med 2022; 25:1434-1445. [PMID: 35027806 PMCID: PMC8693124 DOI: 10.5005/jp-journals-10071-24053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Air leak consisting of pneumothorax, pneumomediastinum, and subcutaneous emphysema has been described as one of the complications of coronavirus disease-2019 (COVID-19) infection affecting disease course and outcome. We aimed to conduct a systematic review of published literature to highlight the risk factors, types, and outcomes in COVID-19. Method A systematic search of PubMed, Embase, Scopus, and Google Scholar was performed from November 1, 2019, to February 28, 2021. Seventy-one studies fulfilled the inclusion criteria and 136 adult patients were included in the final analysis. Results Majority of patients were male (75.2%) with the mean age of 58 years. Hypertension was the most common comorbidity followed by diabetes mellitus. Moreover, 12.5% of patients had a history of smoking while 11.7% had preexisting lung disease. Isolated pneumothorax (48.5%) was the most common and 17.65% had developed spontaneous pneumothorax. Mean onset time was 11.6 days and 67% of patients required an intercostal drainage tube for management. Mortality was 40%, and elderly, female gender, obese and hypertensive were at higher risk. Conclusion COVID-19-related air leaks are associated with higher mortality and longer hospital stay and can occur even without positive pressure ventilation. History of smoking and preexisting lung disease has not been shown to increase the incidence of air leak. A well-designed study is required for a better understanding of COVID-19-related air leak. How to cite this article Singh A, Singh Y, Pangasa N, Khanna P, Trikha A. Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(12):1434–1445.
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Affiliation(s)
- Abhishek Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pangasa
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Saini J, Ranjan A, Meena S, Gupta R, Sharma A. Pneumomediastinum is a poor prognostic factor in COVID-19 patients – case series and review. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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