Details

Autor(en) / Beteiligte

• Palumbo, Diego
• Zangrillo, Alberto
• Belletti, Alessandro
• Guazzarotti, Giorgia
• Calvi, Maria Rosa
• Guzzo, Francesca
• Pennella, Renato
• Monti, Giacomo
• Gritti, Chiara
• Marmiere, Marilena
• Rocchi, Margherita
• Colombo, Sergio
• Valsecchi, Davide
• Scandroglio, Anna Mara
• Dagna, Lorenzo
• Rovere-Querini, Patrizia
• Tresoldi, Moreno
• Landoni, Giovanni
• De Cobelli, Francesco
• Faustini, Carolina
• Maimeri, Nicolò
• Lembo, Rosalba
• Di Lucca, Giuseppe
• Scotti, Raffaella
• Lavorato, Maria Vittoria
• Tomellieri, Alessandro
• Campochiaro, Corrado
• Darvizeh, Fatemeh
• Calabrese, Francesca
• Mapelli, Roberto
• Pasculli, Nicola
• Borghi, Giovanni
• Cipriani, Antonella
• Calabrò, Maria Grazia
• Crivellari, Martina
• Franco, Annalisa
• Pieri, Marina
• Fominskiy, Evgeny V.
• Franchini, Stefano
• Dell'Acqua, Antonio
• Marinosci, Alessandro
• Vitali, Giordano
• Compagnone, Nicola

Titel

A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Ist Teil von

• Journal of critical care, 2021-12, Vol.66, p.14-19

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positives) demonstrated Macklin effect (p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients. •Macklin effect can be regarded as an early detector of lung frailty.•Macklin effect accurately predicts barotrauma in COVID-19 ARDS patients.•Median delay between Macklin effect first evidence and barotrauma onset was 8.5 days.•Patients with Macklin effect might benefit from ultraprotective ventilation strategy.