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.
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