5/6/2023 0 Comments Barotrauma traits![]() kg −1 ideal body weight on average in the LUNG SAFE patients ) and in line with guidelines.kg −1 ideal body weight on average) than what has been previously found (7.5 mL.Indeed, in CoV-ARDS patients, average plateau pressure was 23 cmH 2O, a value lower than the threshold of 30 cmH 2O recommended by current guidelines and lower than the average 26 cmH 2O recorded at the onset of severe ARDS in the LUNG SAFE study patients. Despite the fact that airway pressure in CoV-ARDS patients was higher than that in noCoV-ARDS, the criteria of protective ventilation were respected in CoV-ARDS patients as well. Pulmonary barotrauma in patients with ARDS has traditionally been related to the development of high airway pressure associated with high tidal volume ventilation (∼12 mL The causes of pneumomediastinum in mechanically ventilated patients can be multifactorial. The occurrence of pneumomediastinum/subcutaneous emphysema was rare in noCOV-ARDS but was more frequent in CoV-ARDS even if the same protective ventilatory approach was applied. To the best of our knowledge, this study represents to date the largest cohort of patients who developed pneumomediastinum/subcutaneous emphysema. The diagnosis of pneumomediastinum/subcutaneous emphysema was confirmed by computed tomography (CT) scan or chest radiograph. The second cohort included patients between January 2015, and December 2019, admitted to the ICU with an ARDS diagnosis, before the beginning of the COVID-19 pandemic period in Italy (noCoV-ARDS).Īll data and variables were extracted from the electronic patient registry. Patients admitted until Apwere included in the study. SARS-CoV-2 infection was diagnosed with a positive real-time reverse transcriptase PCR test for SARS-CoV-2 on biological samples. We considered the pandemic period as starting on February 18, 2020, which was the day of the first diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in an Italian patient. ![]() The first cohort included patients with ARDS and COVID-19 (CoV-ARDS) who were admitted to the ICU from the beginning of the COVID-19 pandemic in Italy. Inclusion criteria were: 1) age older than 18 years, 2) ARDS diagnosis at ICU admission and 3) invasive mechanical ventilation. The referral Ethics Committee approved a waiver of consent from individual patients due to the retrospective nature of the study. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in mechanically ventilated COVID-19 patients admitted to ICU was higher than that in ARDS patients without COVID-19, and whether this could be attributed to barotrauma or rather to lung frailty. A decrease in lung compliance, age and underlying lung disease (such as interstitial lung disease, chronic obstructive pulmonary disease cystic fibrosis, and certain lung infections like Pneumocystis jirovecii pneumonia) are known risk factors for non-trauma related pneumomediastinum, Yet the causes of the apparent increase in pneumomediastinum and subcutaneous emphysema in our COVID-19 patients were not clear. Nonetheless, during the COVID-19 pandemic there seemed to be a remarkable increase in pneumomediastinum/subcutaneous emphysema occurrence despite the use of the same unchanged protective mechanical ventilation protocol. In fact, this type of damage had been rarely seen in our ICU patients with ARDS. ![]() In the last two decades, as a consequence of this strategy, the occurrence of the main macroscopic signs of barotrauma such as pneumothorax, pneumomediastinum and subcutaneous emphysema have become very rare. kg −1 of ideal body weight while maintaining the airway plateau pressure below 30 cmH 2O.The current approach to protective ventilation, which became universally accepted after the ARDS Network trial, is based on the reduction of tidal volume to about 6 mL Since the beginning of the novel coronavirus disease 2019 (COVID-19) outbreak in Lombardy, Italy, the Fondazione Poliambulanza Hospital has treated over 2200 affected patients, and over 160 of them were admitted to the intensive care unit (ICU) for treatment of acute respiratory distress syndrome (ARDS) secondary to COVID-19.Īll patients admitted to ICU underwent invasive mechanical ventilation with protective criteria aimed at preventing ventilator-induced lung injury.
0 Comments
Leave a Reply. |