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. 2023 Mar 17;13(6):1156.
doi: 10.3390/diagnostics13061156.

Incidence of Air Leaks in Critically Ill Patients with Acute Hypoxemic Respiratory Failure Due to COVID-19

Robin L Goossen  1 , Mariëlle Verboom  1 , Mariëlle Blacha  1 , Illaa Smesseim  2 , Ludo F M Beenen  3 , David M P van Meenen  1   4 , Frederique Paulus  1   5 , Marcus J Schultz  1   6   7 ; The PRoVENT-Covid And PRoAcT-Covid Investigators
Collaborators, Affiliations

Incidence of Air Leaks in Critically Ill Patients with Acute Hypoxemic Respiratory Failure Due to COVID-19

Robin L Goossen et al. Diagnostics (Basel). .

Abstract

Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2-5) chest radiographs and a median of one (1-2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2-21) days after arrival in the ICU and 18 (9-22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.

Keywords: ARDS; COVID-19; acute hypoxemic respiratory failure; acute respiratory failure; air leaks; barotrauma; chest tube; high-flow nasal oxygen; invasive ventilation; pneumomediastinum; pneumothorax; positive pressure ventilation; subcutaneous emphysema.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT diagram. Patient flow in the parent studies and for this analysis. Abbreviations: PRoVENT–COVID—Practice of Ventilation in COVID-19 patients; PRoAcT–COVID—Practice of Adjunctive Therapies in COVID-19 study; HFNO—high-flow nasal oxygen; UAMC—Amsterdam University Medical Centers; and AMC—Academic Medical Center.
Figure 2
Figure 2
Key ventilation parameters. Cumulative frequency distribution of key ventilation parameters. Vertical dotted lines represent the median for each variable; horizontal dotted lines show the respective proportion of patients reaching the median. Abbreviations: VT—tidal volume; PEEP—positive end-expiratory pressure; Pmax—maximum airway pressure; and CRS—respiratory system compliance.
Figure 3
Figure 3
Time to first confirmation of an air leak. Time from ICU admission to first detection of an air leak on CXR or chest CT scan.
See this image and copyright information in PMC

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