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]
Titolo: | 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 | |
Autori: | SAMARTIN, FEDERICA (Secondo) BRUCATO, ANTONIO LUCA (Penultimo) SALVI, EMANUELE (Ultimo) | |
Parole Chiave: | Pneumothorax; Pneumomediastinum; CPAP; PEEP; COVID-19; SARS-CoV2 | |
Settore Scientifico Disciplinare: | Settore MED/17 - Malattie Infettive Settore MED/09 - Medicina Interna | |
Data di pubblicazione: | 2021 | |
Rivista: | ||
Tipologia: | Article (author) | |
Digital Object Identifier (DOI): | http://dx.doi.org/10.36141/svdld.v38i2.11222 | |
Appare nelle tipologie: | 01 - Articolo su periodico |
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