Background: Acute Hypoxemic Respiratory Failure is a common complication of SARS-CoV2 related pneumonia, for which non-invasive ventilation (NIV) with Helmet Continuous Positive Airway Pressure (CPAP) is widely used. The frequency of pneumothorax in SARS-CoV2 was reported in 0.95% of hospitalized patients in 6% of mechanically ventilated patients, and in 1% of a post-mortem case series. Objectives: Aim of our retrospective study was to investigate the incidence of pneumothorax and pneumomediastinum (PNX/PNM) in SARS-CoV2 pneumonia patients treated with Helmet CPAP. Moreover, we examined the correlation between PNX/PNM and Positive end-expiratory pressure (PEEP) values. Methods: We collected data from patients admitted to "Luigi Sacco" University Hospital of Milan from 2 February to 5 May 2020 with SARS-CoV2 pneumonia requiring CPAP. Patients, who need NIV with bi-level pressure or endotracheal intubation (ETI) for any reason except those who needed ETI after PNX/PNM, were excluded. Population was divided in two groups according to PEEP level used (<= 10 cmH2O and >10 cmH2O). Results: 154 patients were enrolled. In the overall population, 42 patients (27%) were treated with High-PEEP (<= 10 cmH2O), and 112 with Low-PEEP (<= 10 cmH20). During hospitalization 3 PNX and 2 PNM occurred (3.2%). Out of these five patients, 2 needed invasive ventilation after PNX and died. All the PNX/PNM occurred in the High-PEEP group (5/37 vs 0/112, p<0,001). Conclusion: The incidence of PNX appears to be lower in SARS-CoV2 than SARS and MERS. Considering the association of PNX/PNM with high PEEP we suggest using the lower PEEP as possible to prevent these complications.

Correlation between continuous Positive end-expiratory pressure (PEEP) values and occurrence of Pneumothorax and Pneumomediastinum in SARS-CoV2 patients during non-invasive ventilation with Helmet / A. Gidaro, F. Samartin, A.M. Brambilla, C. Cogliati, S. Ingrassia, F. Banfi, V. Cupiraggi, C. Bonino, M. Schiuma, A. Giacomelli, S. Rusconi, J. Currà, A.L. Brucato, E. Salvi. - In: SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES. - ISSN 1124-0490. - 38:2(2021), pp. e2021017.1-e2021017.7. [10.36141/svdld.v38i2.11222]

Correlation between continuous Positive end-expiratory pressure (PEEP) values and occurrence of Pneumothorax and Pneumomediastinum in SARS-CoV2 patients during non-invasive ventilation with Helmet

A. Gidaro
Primo
;
F. Samartin
Secondo
;
A.M. Brambilla;C. Cogliati;F. Banfi;V. Cupiraggi;C. Bonino;M. Schiuma;A. Giacomelli;S. Rusconi;A.L. Brucato
Penultimo
;
E. Salvi
Ultimo
2021

Abstract

Background: Acute Hypoxemic Respiratory Failure is a common complication of SARS-CoV2 related pneumonia, for which non-invasive ventilation (NIV) with Helmet Continuous Positive Airway Pressure (CPAP) is widely used. The frequency of pneumothorax in SARS-CoV2 was reported in 0.95% of hospitalized patients in 6% of mechanically ventilated patients, and in 1% of a post-mortem case series. Objectives: Aim of our retrospective study was to investigate the incidence of pneumothorax and pneumomediastinum (PNX/PNM) in SARS-CoV2 pneumonia patients treated with Helmet CPAP. Moreover, we examined the correlation between PNX/PNM and Positive end-expiratory pressure (PEEP) values. Methods: We collected data from patients admitted to "Luigi Sacco" University Hospital of Milan from 2 February to 5 May 2020 with SARS-CoV2 pneumonia requiring CPAP. Patients, who need NIV with bi-level pressure or endotracheal intubation (ETI) for any reason except those who needed ETI after PNX/PNM, were excluded. Population was divided in two groups according to PEEP level used (<= 10 cmH2O and >10 cmH2O). Results: 154 patients were enrolled. In the overall population, 42 patients (27%) were treated with High-PEEP (<= 10 cmH2O), and 112 with Low-PEEP (<= 10 cmH20). During hospitalization 3 PNX and 2 PNM occurred (3.2%). Out of these five patients, 2 needed invasive ventilation after PNX and died. All the PNX/PNM occurred in the High-PEEP group (5/37 vs 0/112, p<0,001). Conclusion: The incidence of PNX appears to be lower in SARS-CoV2 than SARS and MERS. Considering the association of PNX/PNM with high PEEP we suggest using the lower PEEP as possible to prevent these complications.
Pneumothorax; Pneumomediastinum; CPAP; PEEP; COVID-19; SARS-CoV2
Settore MED/17 - Malattie Infettive
Settore MED/09 - Medicina Interna
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/860045
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