scholarly journals Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

2021 ◽  
Vol 10 (7) ◽  
pp. 1346
Author(s):  
Talida Georgiana Cut ◽  
Cristina Tudoran ◽  
Voichita Elena Lazureanu ◽  
Adelina Raluca Marinescu ◽  
Raluca Dumache ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Diffuse Alveolar Damage ◽  
Demographic Data ◽  
Pathophysiological Mechanism ◽  
Spontaneous Pneumomediastinum ◽  
Intensive Care Stay ◽  
Laboratory Investigations ◽  
Male Patients ◽  
Pulmonary Pathology

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

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 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 Spontaneous Pneumothorax and Pneumomediastinum in COVID 19: Case Series

2021 ◽  
pp. 8-14
Author(s):  
Molano Franco Daniel ◽  
◽  
Valencia Albert ◽  
Nieto Victor ◽  
Robayo Ivan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Spontaneous Pneumothorax ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Spontaneous Pneumomediastinum ◽  
Refractory Hypoxemia ◽  
Bacterial Superinfection ◽  
Worse Prognosis

SARS COV2 infection can produce pneumothorax and spontaneous pneumomediastinum complications, which are associated with a worse prognosis. Here we present a series of cases of patients who presented subcutaneous emphysema caused by pneumothorax or spontaneous pneumomediastinum during care in the intensive care unit for pneumonia and COVID 19. This group of patients showed, in all cases, prolonged mechanical ventilation, refractory hypoxemia and hypercapnia, acute renal failure, bacterial superinfection, need for broad-spectrum antibiotics, and vasopressor support. Keywords: Subcutaneous Emphysema, Spontaneous Pneumothorax, Spontaneous Pneumomediastinum, COVID 19

scholarly journals Transcriptome profiling of the diaphragm in a controlled mechanical ventilation model reveals key genes involved in ventilator-induced diaphragmatic dysfunction

BMC Genomics ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ruining Liu ◽  
Gang Li ◽  
Haoli Ma ◽  
Xianlong Zhou ◽  
Pengcheng Wang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Signaling Pathway ◽  
Wistar Rats ◽  
Cholesterol Metabolism ◽  
Expression Profiles ◽  
Receptor Interaction ◽  
Pathophysiological Mechanism ◽  
Rna Seq ◽  
Diaphragmatic Dysfunction ◽  
Controlled Mechanical Ventilation

Abstract Background Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with weaning difficulties, intensive care unit hospitalization (ICU), infant mortality, and poor long-term clinical outcomes. The expression patterns of long noncoding RNAs (lncRNAs) and mRNAs in the diaphragm in a rat controlled mechanical ventilation (CMV) model, however, remain to be investigated. Results The diaphragms of five male Wistar rats in a CMV group and five control Wistar rats were used to explore lncRNA and mRNA expression profiles by RNA-sequencing (RNA-seq). Muscle force measurements and immunofluorescence (IF) staining were used to verify the successful establishment of the CMV model. A total of 906 differentially expressed (DE) lncRNAs and 2,139 DE mRNAs were found in the CMV group. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to determine the biological functions or pathways of these DE mRNAs. Our results revealed that these DE mRNAs were related mainly related to complement and coagulation cascades, the PPAR signaling pathway, cholesterol metabolism, cytokine-cytokine receptor interaction, and the AMPK signaling pathway. Some DE lncRNAs and DE mRNAs determined by RNA-seq were validated by quantitative real-time polymerase chain reaction (qRT-PCR), which exhibited trends similar to those observed by RNA-sEq. Co-expression network analysis indicated that three selected muscle atrophy-related mRNAs (Myog, Trim63, and Fbxo32) were coexpressed with relatively newly discovered DE lncRNAs. Conclusions This study provides a novel perspective on the molecular mechanism of DE lncRNAs and mRNAs in a CMV model, and indicates that the inflammatory signaling pathway and lipid metabolism may play important roles in the pathophysiological mechanism and progression of VIDD.

scholarly journals Spontaneous pneumomediastinum COVID-19: Impact of mechanical ventilation

2021 ◽  
Vol 10 ◽  
pp. 1
Author(s):  
Rita Oze Koudouhonon ◽  
Suzanne Rita Aubin Igombe ◽  
Biziman Wilson ◽  
Hounayda Rita Aubin Igombe ◽  
Rachida Latib ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Pneumomediastinum

scholarly journals An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre

2015 ◽  
Vol 7 (2) ◽  
pp. 93-96 ◽  
Author(s):  
CB Pratibha ◽  
Deepthi Satish ◽  
Suraj Gopal
Keyword(s):  
Foreign Body ◽  
Subcutaneous Emphysema ◽  
Rare Condition ◽  
Interesting Case ◽  
Valsalva Manoeuvre ◽  
Laryngeal Edema ◽  
Airway Compromise ◽  
Air Leak ◽  
Spontaneous Pneumomediastinum ◽  
Laryngeal Involvement

ABSTRACT Aim To discuss a case of spontaneous pneumomediastinum with pneumothorax with subcutaneous emphysema presenting with stridor due to laryngeal edema with relevant review of literature. Background Spontaneous pneumomediastinum is a rare condition that has been described in healthy individuals following Valsalva manoeuvre, excessive and prolonged cough or emesis. Laryngeal involvement in these cases has not been reported so far. Case description We present an interesting case of spontaneous pneumomediastinum with pneumothorax with pneumopericardium and cervicofacial emphysema with suspected ingestion of foreign body. In view of stridor due to laryngeal edema tracheostomy was done. No obvious cause for the air leak was found on further investigations. The foreign body sensation could have led to oral provocative manoeuvres by the patient causing increased intra-alveolar pressures and air leak. Conclusion Spontaneous pneumomediastinum with cervicofacial emphysema with pneumopericardium with laryngeal involvement is very rare. Tracheostomy is essential in case of airway compromise. A thorough evaluation for the underlying condition is essential to prevent further air leak. Clinical significance In a case of spontaneous pneumomediastinum with airway compromise due to involvement of the larynx, tracheostomy is essential to secure the airway and could also help in resolution of emphysema. How to cite this article Pratibha CB, Satish D, Gopal S, Balasubramanya AM. An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre. Int J Otorhinolaryngol Clin 2015;7(2):93-96.

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

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