scholarly journals Air leak syndrome in COVID-19 – A case series

2021 ◽  
Vol 6 (3) ◽  
pp. 196-200
Author(s):  
Manju Mathew ◽  
Antony Kalliath ◽  
Benju S Varghese ◽  
Alex Mathew
Keyword(s):  
Noninvasive Ventilation ◽  
Case Series ◽  
Underlying Disease ◽  
Positive Pressure ◽  
Respiratory Drive ◽  
Positive End Expiratory Pressure ◽  
Air Leak ◽  
Predicted Body Weight ◽  
Large Fluctuations ◽  
Air Leak Syndrome

Air leak syndrome manifesting as pneumomediastinum (PM), pneumothorax (PNX) or subcutaneous emphysema (SCE) has been reported in COVID-19 patients with increasing frequency and with varying outcomes. We report a series of eight cases of PM or SCE from 1 April to May 31, 2021, among COVID-19 patients admitted in our ICU. All the patients had severe hypoxemia (PaO2/FiO2 ratio ≤100) and were on noninvasive ventilation when the air leak was detected except one. PM/SCE was observed mostly on the 3 to 5 day after instituting positive pressure ventilation. High respiratory drive with mean tidal volumes in the range of 6 to 10ml/kg predicted body weight was observed in these patients. Mean inspiratory pressure (Pressure support + positive end expiratory pressure) and mean positive end expiratory pressure delivered by the ventilator ranged between 11 to 21 and 5 to 12 cm HO respectively. Outcomes varied with four deaths, four patients requiring intubation, two patients requiring chest drainage and four patients showing overall improvement out of the total eight patients with air leak.1.Air leak syndrome is not rare in COVID-19 with reported incidence of 10-14%; 2. Spontaneous noninvasive ventilation in patients with high respiratory drive and large fluctuations in tidal volumes seems to be a risk factor for air leak in patients with severe lung involvement; 3. A conservative approach without intercostal drainage seems to be acceptable in the absence of pneumothorax; 4. Prognosis is varied depending on the underlying disease and not always catastrophic.

Unilateral Lung Intubation for Pulmonary Air Leak Syndrome in Neonates: A Case Series and a Review of the Literature

2010 ◽  
Vol 28 (02) ◽  
pp. 151-156 ◽  
Author(s):  
Leon Joseph ◽  
Ruben Bromiker ◽  
Ori Toker ◽  
Michael Schimmel ◽  
Shmuel Goldberg ◽  
...  
Keyword(s):  
Case Series ◽  
Review Of The Literature ◽  
Air Leak ◽  
Air Leak Syndrome

Air leak with COVID-19 – A meta-summary

2021 ◽  
pp. 021849232110311
Author(s):  
Prashant Nasa ◽  
Deven Juneja ◽  
Ravi Jain
Keyword(s):  
Respiratory Disease ◽  
Positive Pressure Ventilation ◽  
Case Reports ◽  
Final Analysis ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Air Leak Syndrome ◽  
The Individual

Introduction There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes. Methods The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium). Results A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006). Conclusion Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.

scholarly journals Oxygen administration for patients with ARDS

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Shinichiro Ohshimo
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Positive Pressure ◽  
Respiratory Drive ◽  
Severe Hypoxemia ◽  
Airway Occlusion ◽  
Non Invasive ◽  
Oxygen Administration ◽  
Essential Interventions ◽  
Invasive Techniques

AbstractAcute respiratory distress syndrome (ARDS) is a fatal condition with insufficiently clarified etiology. Supportive care for severe hypoxemia remains the mainstay of essential interventions for ARDS. In recent years, adequate ventilation to prevent ventilator-induced lung injury (VILI) and patient self-inflicted lung injury (P-SILI) as well as lung-protective mechanical ventilation has an increasing attention in ARDS.Ventilation-perfusion mismatch may augment severe hypoxemia and inspiratory drive and consequently induce P-SILI. Respiratory drive and effort must also be carefully monitored to prevent P-SILI. Airway occlusion pressure (P0.1) and airway pressure deflection during an end-expiratory airway occlusion (Pocc) could be easy indicators to evaluate the respiratory drive and effort. Patient-ventilator dyssynchrony is a time mismatching between patient’s effort and ventilator drive. Although it is frequently unrecognized, dyssynchrony can be associated with poor clinical outcomes. Dyssynchrony includes trigger asynchrony, cycling asynchrony, and flow delivery mismatch. Ventilator-induced diaphragm dysfunction (VIDD) is a form of iatrogenic injury from inadequate use of mechanical ventilation. Excessive spontaneous breathing can lead to P-SILI, while excessive rest can lead to VIDD. Optimal balance between these two manifestations is probably associated with the etiology and severity of the underlying pulmonary disease.High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) are non-invasive techniques for supporting hypoxemia. While they are beneficial as respiratory supports in mild ARDS, there can be a risk of delaying needed intubation. Mechanical ventilation and ECMO are applied for more severe ARDS. However, as with HFNC/NPPV, inappropriate assessment of breathing workload potentially has a risk of delaying the timing of shifting from ventilator to ECMO. Various methods of oxygen administration in ARDS are important. However, it is also important to evaluate whether they adequately reduce the breathing workload and help to improve ARDS.

Effects of positive end-expiratory pressure on the right ventricle

1986 ◽  
Vol 61 (3) ◽  
pp. 819-826 ◽  
Author(s):  
R. J. Henning
Keyword(s):  
Stroke Volume ◽  
Right Ventricular ◽  
Positive Pressure Ventilation ◽  
Ventricular Volume ◽  
Positive Pressure ◽  
Right Ventricular Volume ◽  
Positive End Expiratory Pressure ◽  
Lung Water ◽  
Fluid Infusion ◽  
Lung Water Content

Transmural cardiac pressures, stroke volume, right ventricular volume, and lung water content were measured in normal dogs and in dogs with oleic acid-induced pulmonary edema (PE) maintained on positive-pressure ventilation. Measurements were performed prior to and following application of 20 cmH2O positive end-expiratory pressure (PEEP). Colloid fluid was given during PEEP for ventricular volume expansion before and after the oleic acid administration. PEEP significantly increased pleural pressure and pulmonary vascular resistance but decreased right ventricular volume, stroke volume, and mean arterial pressure in both normal and PE dogs. Although the fluid infusion during PEEP raised right ventricular diastolic volumes to the pre-PEEP level, the stroke volumes did not significantly increase in either normal dogs or the PE dogs. The fluid infusion, however, significantly increased the lung water content in the PE dogs. Following discontinuation of PEEP, mean arterial pressure, cardiac output, and stroke volume significantly increased, and heart rate did not change. The failure of the stroke volume to increase despite significant right ventricular volume augmentation during PEEP indicates that positive-pressure ventilation with 20 cmH2O PEEP decreases right ventricular function.

Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema

1989 ◽  
Vol 67 (2) ◽  
pp. 817-823 ◽  
Author(s):  
J. I. Sznajder ◽  
C. J. Becker ◽  
G. P. Crawford ◽  
L. D. Wood
Keyword(s):  
Pulmonary Edema ◽  
Positive Pressure Ventilation ◽  
Alveolar Ventilation ◽  
Positive Pressure ◽  
Constant Flow ◽  
Positive End Expiratory Pressure ◽  
Ventilatory Mode ◽  
Continuous Positive Pressure ◽  
Bronchoscopic Guidance ◽  
Normal Lungs

Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

scholarly journals Disseminated Gonococcal Infections in Patients Receiving Eculizumab: A Case Series

2018 ◽  
Vol 69 (4) ◽  
pp. 596-600 ◽  
Author(s):  
Page E Crew ◽  
Winston E Abara ◽  
Lynda McCulley ◽  
Peter E Waldron ◽  
Robert D Kirkcaldy ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Medical Literature ◽  
Treatment Guidelines ◽  
Antimicrobial Prophylaxis ◽  
Case Series ◽  
The United States ◽  
Underlying Disease ◽  
Sexually Transmitted ◽  
Control And Prevention ◽  
Terminal Complement

Abstract Background Gonorrhea is the second most commonly reported notifiable condition in the United States. Infrequently, Neisseria gonorrhoeae can cause disseminated gonococcal infection (DGI). Eculizumab, a monoclonal antibody, inhibits terminal complement activation, which impairs the ability of the immune system to respond effectively to Neisseria infections. This series describes cases of N. gonorrhoeae infection among patients receiving eculizumab. Methods Pre- and postmarketing safety reports of N. gonorrhoeae infection in patients receiving eculizumab worldwide were obtained from US Food and Drug Administration safety databases and the medical literature, including reports from the start of pivotal clinical trials in 2004 through 31 December 2017. Included patients had at least 1 eculizumab dose within the 3 months prior to N. gonorrhoeae infection. Results Nine cases of N. gonorrhoeae infection were identified; 8 were classified as disseminated (89%). Of the disseminated cases, 8 patients required hospitalization, 7 had positive blood cultures, and 2 required vasopressor support. One patient required mechanical ventilation. Neisseria gonorrhoeae may have contributed to complications prior to death in 1 patient; however, the fatality was attributed to underlying disease per the reporter. Conclusions Patients receiving eculizumab may be at higher risk for DGI than the general population. Prescribers are encouraged to educate patients receiving eculizumab on their risk for serious gonococcal infections and perform screening for sexually transmitted diseases (STDs) per the Centers for Disease Control and Prevention STD treatment guidelines or in suspected cases. If antimicrobial prophylaxis is used during eculizumab therapy, prescribers should consider trends in gonococcal antimicrobial susceptibility due to emerging resistance concerns.

scholarly journals Pulmonary air leak syndrome in term and late preterm neonates

2019 ◽  
Vol 147 (9-10) ◽  
pp. 578-582
Author(s):  
Gordana Markovic-Sovtic ◽  
Tatjana Nikolic ◽  
Aleksandar Sovtic ◽  
Jelena Martic ◽  
Zorica Rakonjac
Keyword(s):  
Mechanical Ventilation ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Late Preterm ◽  
Respiratory Support ◽  
Medical Emergency ◽  
Preterm Neonates ◽  
Air Leak ◽  
Average Birth Weight ◽  
Air Leak Syndrome

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ? 1.9 g.w. were included in the study. The average birth weight was 3182.5 ? 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

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