scholarly journals Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review

2020 ◽  
Vol 13 (12) ◽  
pp. e239489
Author(s):  
Tarig Sami Elhakim ◽  
Haleem S Abdul ◽  
Carlos Pelaez Romero ◽  
Yoandy Rodriguez-Fuentes
Keyword(s):  
Literature Review ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Stable Condition ◽  
Positive Pressure ◽  
Unusual Complication ◽  
Pathophysiological Mechanism ◽  
Air Leak ◽  
Non Invasive ◽  
Spontaneous Pneumomediastinum

Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.

scholarly journals A case of spontaneous pneumomediastinum in a patient with severe SARS-CoV-2 and a review of the literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Duong T Hua ◽  
Farah Shah ◽  
Cherlyn Perez-Corral
Keyword(s):  
Subcutaneous Emphysema ◽  
Lung Diseases ◽  
Illicit Drugs ◽  
Positive Pressure Ventilation ◽  
Rare Complication ◽  
Positive Pressure ◽  
Chest Imaging ◽  
Shortness Of Breath ◽  
Spontaneous Pneumomediastinum ◽  
Hypoxic Respiratory Failure

Spontaneous pneumomediastinum is defined as having an etiology that is not related to surgery, trauma, or mechanical ventilation. Precipitating causes of spontaneous pneumomediastinum include coughing, exercise, vomiting, infection, underlying lung diseases such as asthma, and illicit drugs. Symptoms include chest pain, shortness of breath, and dysphagia. A 54-year-old man presented with 2 weeks of shortness of breath, cough, and fever. He was admitted for severe SARS-CoV-2 pneumonia and acute hypoxic respiratory failure requiring non-rebreather mask. Chest imaging on admission showed bilateral peripheral consolidations and pneumomediastinum with subcutaneous emphysema. No precipitating event was identified. He did not require initiation of positive pressure ventilation throughout his admission. On hospital day 7, chest imaging showed resolution of pneumomediastinum and subcutaneous emphysema, and he was successfully discharged on oxygen therapy. Spontaneous pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 infection. Spontaneous pneumomediastinum is typically benign and self-limiting, requiring only supportive treatment.

scholarly journals Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan

2021 ◽  
Vol 149 ◽  
Author(s):  
S. M. Sethi ◽  
A. S. Ahmed ◽  
S. Hanif ◽  
M. Aqeel ◽  
A. B. S. Zubairi
Keyword(s):  
Hospital Stay ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Pressure ◽  
Care Hospital ◽  
Spontaneous Pneumomediastinum ◽  
Disease Case

Abstract Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23–75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5–10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8−25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.

scholarly journals Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Vikisha Hazariwala ◽  
Hind Hadid ◽  
Denise Kirsch ◽  
Cecilia Big
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Laboratory Data ◽  
Positive Pressure ◽  
Case Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Important Complication ◽  
Underlying Pathophysiology

Abstract Background Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. Case presentation We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. Conclusions Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.

scholarly journals 1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A481-A481
Author(s):  
V Nuzhny ◽  
E C Kleerup ◽  
M R Zeidler
Keyword(s):  
Treatment Efficacy ◽  
Positive Pressure Ventilation ◽  
Innovative Technology ◽  
Positive Pressure ◽  
Delivery Mode ◽  
Air Leak ◽  
3D Print ◽  
Non Invasive ◽  
3D Printed ◽  
Device Use

Abstract Introduction Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia. Report of Case This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask. Conclusion This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.

scholarly journals The Effect of a Non-Invasive Positive Pressure Ventilation Simulation Program on General Ward Nurses’ Knowledge and Self-Efficacy

2021 ◽  
Vol 18 (6) ◽  
pp. 2877
Author(s):  
Moon-Sook Kim ◽  
Mi-Hee Seo ◽  
Jin-Young Jung ◽  
Jinhyun Kim
Keyword(s):  
Self Efficacy ◽  
Qualitative Data ◽  
Positive Pressure Ventilation ◽  
Intervention Group ◽  
General Ward ◽  
Simulation Program ◽  
Positive Pressure ◽  
Control Group ◽  
Training Strategy ◽  
Non Invasive

The purpose of this study is to develop a simulation-based ventilator training program for general ward nurses and identify its effects. Quantitative data were collected from 29 nurses (intervention group: 15, control group: 14), of which seven were interviewed with focus groups to collect qualitative data. The quantitative results revealed significant differences in ventilator-related knowledge (p = 0.029) and self-efficacy (p = 0.026) between the intervention and control groups. Moreover, three themes were derived from meaningful statements in the qualitative data: understanding psychophysical discomfort of the patient while applying the ventilator; helping in ventilator care; and establishing a future ventilator training strategy. The findings confirmed that the non-invasive positive pressure ventilation (NPPV) simulation program is an effective method for improving the knowledge of ventilator nursing and self-efficacy and will be helpful in developing educational methods and strategies related to ventilator nursing for general ward nurses.

Sign in / Sign up

Export Citation Format

Share Document