Clinical, Laboratory and Radiological Evaluation of Intensive Care Patients Who Developed COVID-19 Associated Pneumomediastinum

Deniz Esin Sanli; Elif Gulek; Neval Erozan; Serpil Kurtcan; Ibrahim Dikmen; Ahmet Necati Sanli; Ceyda Erel Kirisoglu; Duzgun Yildirim; Oner Dikensoy; Ibrahim Ozkan Akinci

doi:10.58600/eurjther996

Authors

Deniz Esin Sanli Department of Radiology, Gaziantep University Faculty of Medicine https://orcid.org/0000-0002-6545-5757
Elif Gulek Department of Anesthesiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey https://orcid.org/0000-0003-1773-5866
Neval Erozan Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey https://orcid.org/0000-0001-8609-6194
Serpil Kurtcan Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey https://orcid.org/0000-0002-8207-0824
Ibrahim Dikmen Department of Anesthesiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey https://orcid.org/0000-0003-0774-9578
Ahmet Necati Sanli Department of General Surgery, Abdulkadir Yüksel State Hospital, Gaziantep, Turkey https://orcid.org/0000-0002-1483-8176
Ceyda Erel Kirisoglu Deparatment of Chest Diseases, Acibadem Kozyatagi Hospital, Istanbul, Turkey https://orcid.org/0000-0002-4284-3474
Duzgun Yildirim Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey and Department of Medical Imaging Techniques, Vocational School of Health, Acibadem University, Istanbul, Turkey https://orcid.org/0000-0002-5411-229X
Oner Dikensoy Department of Anesthesiology, Acibadem Taksim Hospital, Istanbul, Turkey https://orcid.org/0000-0003-1161-6225
Ibrahim Ozkan Akinci Department of Anesthesiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey https://orcid.org/0000-0003-1657-3869

DOI:

https://doi.org/10.58600/eurjther996

Keywords:

COVID-19, pneumomediastinum, mortality, Computed Tomography

Abstract

Objective: This study aims to identify possible risk factors and clinical, laboratory, or radiological predictors for COVID-19 associated pneumomediastinum.

Methods: Patients who developed pneumomediastinum under mechanical ventilation (MV) due to COVID-19 pneumonia during intensive care unit (ICU) (Group 1), and patients who died without developing pneumomediastinum during ICU (Group 2) were compared statistically in terms of age, laboratory parameters, medical treatments, mechanical ventilator parameters, and radiological findings.

Results: Group 1 patients were significantly younger than Group 2 patients (p<0.05). There was no significant difference between groups in terms of laboratory parameters except N/L ratios and sedimentation rates (p>0.05). There was no significant difference between the groups in terms of dominant infiltration pattern, pleural and pericardial effusion (p>0.05). The incidence of organizing pneumonia pattern, and infiltration of more than 75% of the total lung parenchyma were significantly higher in Group 1 (p<0.01). The rates of favipiravir treatment, immunomodulatory therapy and prone positioning were significantly lower in Group 1 than Group 2 (p<0.01). There was no significant difference between groups in terms of the duration of ICU hospitalization and MV, PEEPmax, PIPmax and PaO2/FiO2 (p>0.05).

Conclusion: Care should be taken in terms of pneumomediastinum in patients who show diffuse organized pneumonia patterns affecting more than 75% of the parenchyma area.

Metrics

Metrics Loading ...

Author Biography

Deniz Esin Sanli, Department of Radiology, Gaziantep University Faculty of Medicine

References

Johansson MA, Quandelacy TM, Kada S, Prasad PV, Steele M, Brooks JT, et al. (2021) SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA network open. 4(1):e2035057. https://doi.org/10.1001/jamanetworkopen.2020.35057

Fajgenbaum DC, June CH. (2020) Cytokine Storm. N Engl J Med. 383(23):2255-2273. https://doi.org/10.1056/NEJMra2026131

Luo M, Cao S, Wei L, Zhao X, Gao F, Li S, et al. (2020) Intubation, mortality, and risk factors in critically ill Covid-19 patients: A pilot study. J Clin Anesth. 67:110039. https://doi.org/10.1016/j.jclinane.2020.110039

Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. (2020) China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 55(5):2000547. https://doi.org/10.1183/13993003.00547-2020

Elhakim TS, Abdul HS, Pelaez Romero C, Rodriguez-Fuentes Y. (2020) Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review. BMJ Case Rep. 13(12):e239489. https://doi.org/10.1136/bcr-2020-239489

Kangas-Dick A, Gazivoda V, Ibrahim M, Sun A, Shaw JP, Brichkov I, et al. (2021) Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia. J Laparoendosc Adv Surg Tech A. 31(3):273-278. https://doi.org/10.1089/lap.2020.0692

Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. (2020) Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging. 2(2):e200152. https://doi.org/10.1148/ryct.2020200152

Pogatchnik BP, Swenson KE, Sharifi H, Bedi H, Berry GJ, Guo HH. (2020) Radiology-Pathology Correlation Demonstrating Organizing Pneumonia in a Patient Who Recovered from COVID-19. Am J Respir Crit Care Med. 202(4):598-599. https://doi.org/10.1164/rccm.202004-1278IM

Tekcan Sanli DE, Yildirim D, Sanli AN, Erozan N, Husmen G, Altundag A, et al. (2021) Predictive value of CT imaging findings in COVID-19 pneumonia at the time of first-screen regarding the need for hospitalization or intensive care unit. Diagn Interv Radiol. 27(5):599-606. https://doi.org/10.5152/dir.2020.20421

Simsek EE, Guner AE, Kul S, Karakurt Z, Tekesin K, Birinci S. (2020) A comparative analysis of the COVID-19 pandemic response: The case of Turkey. North Clin Istanb. 7(5):443-451. https://doi.org/10.14744/nci.2020.87846

Jordan RE, Adab P, Cheng KK. (2020) Covid-19: risk factors for severe disease and death. BMJ. 368:m1198. https://doi.org/10.1136/bmj.m1198

Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, et al. (2020) Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience. Anesthesiology. 132(6):1317-1332. https://doi.org/10.1097/ALN.0000000000003296

Ghani M, Rodriguez-Ortiz Y, Ahmad D, Pham J, Tamsukhin P, Mir P. (2020) Spontaneous pneumomediastinum in patients with SARS-Cov-2 virus (COVID-19). Chest. 158(4):A1231-2. https://doi.org/10.1016/j.chest.2020.08.1121

Kolani S, Houari N, Haloua M, Alaoui Lamrani Y, Boubbou M, Serraj M, et al. (2020) Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection. IDCases. 21:e00806. https://doi.org/10.1016/j.idcr.2020.e00806

Anzueto A, Frutos-Vivar F, Esteban A, Alía I, Brochard L, Stewart T, et al. (2004) Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Med. 30(4):612-9. https://doi.org/10.1007/s00134-004-2187-7

McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, Thomas KM, Moore WH. (2020) Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 297(2):E252-E262. https://doi.org/10.1148/radiol.2020202352

Wali A, Rizzo V, Bille A, Routledge T, Chambers AJ. (2020) Pneumomediastinum following intubation in COVID-19 patients: a case series. Anaesthesia. 75(8):1076-1081. https://doi.org/10.1111/anae.15113

Sanli DET, Altundag A, Kandemirli SG, Yildirim D, Sanli AN, Saatci O, et al. (2021) Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia. Am J Otolaryngol. 42(1):102796. https://doi.org/10.1016/j.amjoto.2020.102796

Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. (2020) Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 510:475-482. https://doi.org/10.1016/j.cca.2020.08.019

de Oliveira Filho CM, Vieceli T, de Fraga Bassotto C, da Rosa Barbato JP, Garcia TS, Scheffel RS. (2021) Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids. Braz J Infect Dis. 25(1):101541. https://doi.org/10.1016/j.bjid.2021.101541

Kory P, Kanne JP. (2020) SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’. BMJ Open Respir Res. 7(1):e000724. https://doi.org/10.1136/bmjresp-2020-000724

Manabe T, Kambayashi D, Akatsu H, Kudo K. (2021) Favipiravir for the treatment of patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 21(1):489. https://doi.org/10.1186/s12879-021-06164-x

Zhao M. (2020) Cytokine storm and immunomodulatory therapy in COVID-19: Role of chloroquine and anti-IL-6 monoclonal antibodies. Int J Antimicrob Agents. 55(6):105982. https://doi.org/10.1016/j.ijantimicag.2020.105982

Alijotas-Reig J, Esteve-Valverde E, Belizna C, Selva-O’Callaghan A, Pardos-Gea J, Quintana A, et al. (2020) Immunomodulatory therapy for the management of severe COVID-19. Beyond the anti-viral therapy: A comprehensive review. Autoimmun Rev. 19(7):102569. https://doi.org/10.1016/j.autrev.2020.102569

van der Veer T, van der Sar-van der Brugge S, Paats MS, van Nood E, de Backer IC, Aerts JGJV, et al. (2021) Do-not-intubate status and COVID-19 mortality in patients admitted to Dutch non-ICU wards. Eur J Clin Microbiol Infect Dis. 40(10):2207-2209. https://doi.org/10.1007/s10096-021-04223-4

Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. (2021) Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med. 25(5):493-498. https://doi.org/10.5005/jp-journals-10071-23816