Dept of Anesthesia and Intensive Care, Fondazione Poliambulanza, Brescia, Italy.
Published: October 2020
AI Article Synopsis
Article Abstract
Background: In mechanically ventilated acute respiratory distress syndrome (ARDS) patients infected with the novel coronavirus disease (COVID-19), we frequently recognised the development of pneumomediastinum and/or subcutaneous emphysema despite employing a protective mechanical ventilation strategy. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in COVID-19 patients was higher than in ARDS patients without COVID-19 and if this difference could be attributed to barotrauma or to lung frailty.
Methods: We identified both a cohort of patients with ARDS and COVID-19 (CoV-ARDS), and a cohort of patients with ARDS from other causes (noCoV-ARDS).Patients with CoV-ARDS were admitted to an intensive care unit (ICU) during the COVID-19 pandemic and had microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period.
Results: Pneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in three out of 163 (1.9%) patients with noCoV-ARDS (p<0.001). Mortality was 56.5% in CoV-ARDS patients with pneumomediastinum/subcutaneous emphysema and 50% in patients without pneumomediastinum (p=0.46).CoV-ARDS patients had a high incidence of pneumomediastinum/subcutaneous emphysema despite the use of low tidal volume (5.9±0.8 mL·kg ideal body weight) and low airway pressure (plateau pressure 23±4 cmHO).
Conclusions: We observed a seven-fold increase in pneumomediastinum/subcutaneous emphysema in CoV-ARDS. An increased lung frailty in CoV-ARDS could explain this finding more than barotrauma, which, according to its etymology, refers to high transpulmonary pressure.
Subcutaneous emphysema, caused by the presence of air or gas in subcutaneous tissues, can be infectious or noninfectious. A thorough clinical evaluation, including both physical examination and radiological imaging, is required to distinguish benign subcutaneous emphysema from necrotizing soft tissue infections. In this article, we report a 12-year-old female patient with benign subcutaneous emphysema of the upper extremity and highlight the importance of an accurate diagnosis to avoid unnecessary surgical intervention.
A 67-year-old female presented to the emergency department after falling on her chest. On initial presentation, her chest wall was tender to palpation with mild overlying ecchymosis. Initial imaging demonstrated a sternal body fracture with minimal retrosternal hematoma.
In high-risk patients undergoing emergency tracheostomy, especially with advanced malignancies and comorbidities, vigilant monitoring and immediate management of complications like extensive subcutaneous emphysema are crucial. Prompt intervention and interdisciplinary collaboration are essential to optimize outcomes and effectively address severe postoperative issues.
Subcutaneous emphysema is the accumulation of gas or air in loose subcutaneous connective tissue. The use of air-driven handpieces in dental procedures is a common iatrogenic cause of intraoral mucogingival barrier disruption by high-pressure air. This case report describes a 60-year-old woman who underwent prophylactic periodontal treatment with an air-abrasive device and subsequently developed severe bilateral subcutaneous emphysema, extending from the temporal region to the thoracic and mediastinal spaces.
Background: Alpha-1 antitrypsin deficiency (AATD) is associated with increased susceptibility to chronic obstructive pulmonary disease (COPD). AATD results from mutations in the SERPINA1 gene and over 500 rare mutations have been identified. Despite these findings and recommendations from major healthcare organizations, testing of COPD patients and their family members for AATD remains inadequate.
