The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax
Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pne...
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| Format: | Article |
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MDPI AG
2021-05-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/9/6/620 |
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| author | Francesca Simioli Anna Annunziata Giorgio Emanuele Polistina Antonietta Coppola Valentina Di Spirito Giuseppe Fiorentino |
| author_facet | Francesca Simioli Anna Annunziata Giorgio Emanuele Polistina Antonietta Coppola Valentina Di Spirito Giuseppe Fiorentino |
| author_sort | Francesca Simioli |
| collection | DOAJ |
| description | Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (<i>n</i> = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (<i>n</i> = 10) or invasive mechanical ventilation (IMV) (<i>n</i> = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax. |
| first_indexed | 2024-03-10T11:08:58Z |
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| id | doaj.art-090ab6e5b8dd41e89b699263760f3f6a |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-10T11:08:58Z |
| publishDate | 2021-05-01 |
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| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-090ab6e5b8dd41e89b699263760f3f6a2023-11-21T20:56:20ZengMDPI AGHealthcare2227-90322021-05-019662010.3390/healthcare9060620The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and PneumothoraxFrancesca Simioli0Anna Annunziata1Giorgio Emanuele Polistina2Antonietta Coppola3Valentina Di Spirito4Giuseppe Fiorentino5Sub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalySub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalySub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalySub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalySub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalySub-intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi–A.O. Dei Colli, Via Gaetano Quagliariello 54, 80131 Naples, ItalyBackground: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (<i>n</i> = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (<i>n</i> = 10) or invasive mechanical ventilation (IMV) (<i>n</i> = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax.https://www.mdpi.com/2227-9032/9/6/620critical COVID-19non-invasive ventilationmechanical ventilationARDSP-SILI |
| spellingShingle | Francesca Simioli Anna Annunziata Giorgio Emanuele Polistina Antonietta Coppola Valentina Di Spirito Giuseppe Fiorentino The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax Healthcare critical COVID-19 non-invasive ventilation mechanical ventilation ARDS P-SILI |
| title | The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax |
| title_full | The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax |
| title_fullStr | The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax |
| title_full_unstemmed | The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax |
| title_short | The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax |
| title_sort | role of high flow nasal cannula in covid 19 associated pneumomediastinum and pneumothorax |
| topic | critical COVID-19 non-invasive ventilation mechanical ventilation ARDS P-SILI |
| url | https://www.mdpi.com/2227-9032/9/6/620 |
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