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Spontaneous pneumomediastinum (PMS) is defined as free air within the mediastinum. Spontaneous pneumothorax (PNX) consists of the presence of air inside the pleural space. PMS and PNX may sometimes occur secondly to an underlying pathology, or deriving from a sudden increase in intra-alveolar pressure such as functional alteration such as airway hyperactivity, Valsalva maneuver, cough, barotrauma, and/or volutrauma with consequent rupture of the alveoli and subsequent leakage of air into the mediastinum due to the Macklin effect. The escaping air can then spread inside the pericardium, the peritoneum, the muscles, and subcutaneous tissues, hence causing subcutaneous emphysema.
PMS and PNX are rare complications of several lung infections such as Pneumocystis Jirovecii pneumonia, tuberculosis, bacterial necrotizing pneumonia, and herpes pneumonia.
However, an increasing number of PMS and PNX has been described in patients with SARS-CoV2 interstitial pneumonia. PMS and PNX can either present as the onset manifestation of COVID-19 disease, or occur as complications of non-invasive and/or invasive ventilation, or following to cystic and/or fibrotic evolution of the pathology.
The frequency of PMS and PNX during COVID-19 is not well defined, as the available data are limited to case collections and single reports. According to currently available scientific literature, PNX in COVID-19 occurs with frequency rates of 1-3%, up to 6% in patients undergoing non-invasive ventilation (NIV) and mechanical artificial ventilation (VAM). In McGuinness's analysis, which compared the complications of barotrauma in patients with acute respiratory distress syndrome (ARDS) in VAM, PNX and PMS occurred with frequency rates of 9% and 10%, respectively, while in non-COVID-19 population, PNX and PMS frequency rates were 12% and 3%, respectively.
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| Measure | Description | Time Frame |
|---|---|---|
| Barotrauma occurrence with different respiratory strategies | Effect of the different respiratory support strategies on barotrauma (pneumomediastinum and/or pneumothorax) occurrence | February 20, 2020 - March 31, 2021 |
| Measure | Description | Time Frame |
|---|---|---|
| Pneumomediastinum and pneumothorax | Estimating pneumomediastinum and pneumothorax frequency rates in hospitalized COVID-19 patients | February 20, 2020 - March 31, 2021 |
| Risk factors other than ventilation strategy |
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Inclusion Criteria:
Exclusion Criteria:
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Hospitalized patients with SARS-COV2 infection
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Policlinico S.Orsola-Malpighi, Pneumologia e Terapia Intensiva Respiratoria | Bologna | Italy | ||||
| Policlinico S.Orsola-Malpighi, U.O Malattie Infettive |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 6375617 | Background | Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med. 1984 Jul;144(7):1447-53. | |
| 32330274 | Background | Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med. 2020 Aug 20;27(5):taaa062. doi: 10.1093/jtm/taaa062. |
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Evaluating risk factors associated with barotrauma (spontaneous breathing, non-invasive, invasive, or extracorporeal circulation) in hospitalized COVID-19 patients
| February 20, 2020 - March 31, 2021 |
| 30-day outcome | Assessment of the in-hospital outcome, intended as "survival days" in hospitalized COVID-19 patients who manifest barotrauma | 30 days |
| Bologna |
| Italy |
| Azienda Ospedaliero-Universitaria V.Emanuele Ferrarotto, S.bambino, Malattie Infettive | Catania | Italy |
| Azienda Ospedaliero-Universitaria V.Emanuele Ferrarotto, S.bambino, U.O.C. di Malattie Infettive | Catania | Italy |
| Azienda Ospedaliera S.Croce e Carle Cuneo, SC Malattie Infettive e tropicali, | Cuneo | Italy |
| Ospedale Policlinico San Martino-IRCCS, Clinica di Malattie Infettive e Tropicali | Genova | Italy |
| Fondazione IRCCS, Ca Granda Ospedale Maggiore Policlinico, UOC, Malattie Infettive | Milan | Italy |
| Ospedale dei colli, Malattie Infettive ed Urgenze Infettivologiche, | Naples | Italy |
| Azienda Ospedaliera di Padova, S.C di Fisiopatologia respiratoria, | Padova | Italy |
| Unità Operativa Complessa Istituto di Anestesia e Rianimazione dell'Azienda Ospedale-Università di Padova, | Padova | Italy |
| Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo, UOC Anestesia Rianimazione con Terapia Intensiva Polivalente e del Dolore | Palermo | Italy |
| Azienda Ospedaliero-Universitaria di Parma, Clinica Pneumologica | Parma | Italy |
| Azienda Ospedaliera Perugia, Malattie Infettive | Perugia | Italy |
| Azienda USL Toscana Ovest, Ospedale Felice Lotti SOC Medicina Interna | Pontedera | Italy |
| Azienda Sanitaria Universitaria Friuli Occidentale, S.C Pneumologia | Pordenone | Italy |
| AOU Città della Salute e Scienza, SC Malattie Infettive | Torino | Italy |
| Azienda Ospedaliera Ordine Mauriziano S.C. Pneumologia e Unità di Terapia Semi Intensiva Respiratoria | Torino | Italy |
| Ospedale Cardinal Massaia, SC Malattie Infettive | Torino | Italy |
| Azienda Sanitaria Universitaria Giuliano Isontina, S.C Pneumologia | Trieste | Italy |
| Anesthesiology and Intensive Care Clinic - Department of Medicine - ASUIUD | Udine | 33100 | Italy |
| Azienda ospedaliero universitaria Friuli Centrale, Anestesia e Rianimazione 1 | Udine | Italy |
| Azienda ospedaliero universitaria Friuli Centrale, Anestesia e Rianimazione 2 | Udine | Italy |
| Azienda ospedaliero universitaria Friuli Centrale, Clinica di Anestesia e Rianimazione | Udine | Italy |
| Azienda Ospedaliero Universitaria Friuli Centrale, Malattie infettive | Udine | Italy |
| Azienda Ospedaliero Universitaria Friuli Centrale, Pneumologia | Udine | Italy |
| Azienda Sanitaria locale di Vercelli, Malattie infettive | Vercelli | Italy |
| Università di Verona, Clinica delle Malattie Infettive e Tropicali | Verona | Italy |
| 32007143 | Background | Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7. Epub 2020 Jan 30. |
| 32312571 | Background | Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, Xiao W, Yao S, Mei W, Chen X, Luo A, Sun L, Cook T, Behringer E, Huitink JM, Wong DT, Lane-Fall M, McNarry AF, McGuire B, Higgs A, Shah A, Patel A, Zuo M, Ma W, Xue Z, Zhang LM, Li W, Wang Y, Hagberg C, O'Sullivan EP, Fleisher LA, Wei H; collaborators. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth. 2020 Jul;125(1):e28-e37. doi: 10.1016/j.bja.2020.03.026. Epub 2020 Apr 10. |
| 32614258 | Background | McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, Thomas KM, Moore WH. Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 2020 Nov;297(2):E252-E262. doi: 10.1148/radiol.2020202352. Epub 2020 Jul 2. |
| 36669936 | Derived | Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V; Italian COVI-MIX Study Group; De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology. 2023 Nov-Dec;29(6):457-468. doi: 10.1016/j.pulmoe.2022.11.002. Epub 2022 Nov 24. |
| ID | Term |
|---|---|
| D011030 | Pneumothorax |
| D008478 | Mediastinal Emphysema |
| ID | Term |
|---|---|
| D010995 | Pleural Diseases |
| D012140 | Respiratory Tract Diseases |
| D008477 | Mediastinal Diseases |
| D013896 | Thoracic Diseases |
| D004646 | Emphysema |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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