![]() ![]() The readers were not blinded to the diagnosis of COVID-19, however, they were blinded to the clinical report including the presence of pneumomediastinum, subcutaneous emphysema, and pneumothorax as well as the clinical characteristics of each case. Radiographs were reviewed independently, and final decisions were reached by consensus. In the subset of 43 patients with pneumomediastinum and/or subcutaneous emphysema without preceding pneumothorax, we conducted an image review of all 419 radiographs to determine the timeline of pneumomediastinum development and resolution in relation to mechanical ventilation.Īll chest radiographs were reviewed by a cardiothoracic radiologist with >10 years of experience and a cardiothoracic imaging fellow using a picture archiving and communication system (PACS) workstation. Additional variables including length of intubation and ventilator settings (tidal volume, fraction of inspired oxygen (FiO 2), peak end expiratory pressure (PEEP), respiratory rate, plateau pressure) were obtained through chart review. An image review of all radiographs ( n = 419) belonging to these patients was performed.Ĭlinically relevant variables obtained from the institutionally compiled COVID-19 dataset included age, sex, ethnicity, race, body mass index (BMI), asthma, chronic obstructive pulmonary disease (COPD), hypertension (HTN), diabetes, cancer, chronic kidney disease (CKD), heart failure, ARDS, and smoking history. The radiology reports were manually reviewed for any mention of pneumomediastinum or subcutaneous emphysema and 43/363 (12%) patients with at least one of these findings were identified. ![]() The secondary outcomes of interest were length of intubation and death. The primary outcomes of interest were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. A total of 2178 chest radiographs were reviewed. The earliest intubation period was and the last discharge date was covering the study period. Based on the provided intubation date, subsequent chest radiograph reports were extracted for each patient and were reviewed to identify the primary outcomes of interest. After this exclusion, 363 patients were included for analysis. Patients with findings consistent with air leak on initial imaging were excluded ( N = 4). Using the mPower ™ (Nuance, Burlington, Massachusetts, United States) search and analytics platform, radiology information system (RIS) data were extracted for each patient and the initial chest radiograph on the day of intubation was identified for review. Using an institutionally compiled COVID-19 dataset, we identified 367 patients over the age of 18 with reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 who were intubated for at least two days from March 1 to Apin three hospital centers within the Mount Sinai Health System in New York City. This multi-center retrospective study was approved by our institutional review board. We investigate these features, describe the radiographic patterns of barotrauma, and delineate the timeline of development in relation to mechanical ventilation and the relationship to patient mortality. The risk factors associated with barotrauma have not been evaluated in the COVID-19 population. Similar findings in SARS-COV-1 and ARDS have led authors to question whether these findings may be associated with increasing disease severity and poorer outcomes. These studies suggest that underlying decreased lung compliance may place these patients at an increased risk for these complications. Furthermore, cases of COVID-19 with associated spontaneous pneumomediastinum, subcutaneous emphysema, and pneumothorax in the non-intubated population have recently been described in the literature. 7 Similar rates (25%) have been reported in severe acute respiratory syndrome (SARS-COV-1) 8 of 25% and from 10 to 67% in the acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) literature. 6 Although there is a paucity of literature describing barotrauma in COVID-19 patients, the reported barotrauma rate (15%) is higher than the non COVID-19 mechanically ventilated population. Barotrauma, including pneumomediastinum, subcutaneous emphysema, pneumoretroperitoneum, pneumoperitoneum, and pneumothorax are known complications of mechanical ventilation. and mechanical ventilation is associated with an increased risk of death in these critically ill patients. The reported mortality rates of intubated COVID-19 patients ranges from 66 to 97% 3., 4. ![]() The Coronavirus disease (COVID-19) global pandemic has contributed to over 5.2 million deaths worldwide. ![]()
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