POSTER SECTIONS Coverpage Purpose Methods and materials Results Conclusion Personal information and conflict of interest References

ECR 2021 / C-15255

Ventilatory complications in patients with COVID-19: the importance of diagnosis in barotrauma

Congress:

ECR 2021

Poster Number:

C-15255

Type:

Scientific Exhibit

Keywords:

Lung, CT, Plain radiographic studies, Complications, Outcomes analysis, Infection, Inflammation, Trauma

Authors:

A. A. S. M. D. Santos, A. R. S. SANTOS, C. D. L. Fernando, M. Moraes, S. Vinhas, M. Damasceno, F. Oliveira, M. Bellas, W. Martins; Niterói - Rio de Janeiro/BR

DOI:

10.26044/ecr2021/C-15255

DOI-Link:

https://dx.doi.org/10.26044/ecr2021/C-15255

Purpose

Review the pathophysiology of pulmonary and thoracic complications resulting from barotrauma secondary to mechanical ventilation. Demonstrate the main radiological findings of COVID-19 patients who presented complications of ventilatory assistance and which are important for the knowledge of radiologists.

Methods and materials

Pneumomediastinum is a rare condition in which air is present in the mediastinum. Frequently occurs as a result of blunt trauma or oesophageal perforation. It can also occur spontaneously, having as main causes those related to the Valsalva maneuver and asthma. Reports of spontaneous pneumomediastinum unrelated to mechanical ventilation have been published in patients with COVID-19 and severe acute respiratory syndrome (SARS). The most likely mechanism of pneumomediastinum formation in the context of COVID-19 is the appearance of a pressure gradient between the alveoli and...

Results

All patients admitted to our ICU with laboratory-proven COVID-19 who required mechanical ventilation were assisted by a multidisciplinary team of health professionals, including physicians, nurses and specialized physiotherapists, following safety protocols at the time of intubation and monitoring of mechanical ventilation parameters. In this observational study we found 9 cases with pneumomediastinum, all with severe pulmonary symptoms and who were intubated and under mechanical prolonged mechanical ventilation. All of them also presented soft tissue emphysema, with varying lengths. Two cases had a small unilateral pneumothorax....

Conclusion

Pneumomediastinum can be a significant complication in patients affected by a respiratory infection caused by Covid-19, usually associated with severe cases, especially in those with ventilatory assistance. It is essential to know the complications resulting from mechanical ventilation in patients with COVID-19. Besides, early signs should be valued in order to alert the attending medical staff to avoid worsening changes resulting from barotrauma

Personal information and conflict of interest

A. S. Santos: Nothing to disclose A. R. S. SANTOS: Nothing to disclose C. d. L. Fernando: Nothing to disclose M. Moraes: Nothing to disclose S. Vinhas: Nothing to disclose M. Damasceno: Nothing to disclose F. Oliveira: Nothing to disclose M. Bellas: Nothing to disclose W. Martins: Nothing to disclose

References

Goldman,N.;Ketheeswaran,B.;WIlson,H. COVID-19-associated pneumomediastinum. Clin Med (Lond).2020 Jul;20(4):e91-e92. doi: 10.7861/clinmed.2020-0247. Epub 2020 May 22. Kangas-Dick, A.; Gazivoda,V.; Ibrahim, M.; Sun, A.; Shaw. J.P.; Brichkov, I. and Wiesel O. Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia. J Laparoendosc Adv Surg Tech A. 2020 Sep 16. doi: 10.1089/lap.2020.0692. Muniz, B. C.; Zanetti, G.; Marchiori, E. Pneumomediastinum in a patient with COVID-19 . Bras. Pneumol. vol.46 no.3 São Paulo 2020 Epub June 15,2020. https://doi.org/10.36416/1806-3756/e20200190. Romano, N.; Fischetti, A.; MelanI, E. F. Pneumomediastinum Related to Covid-19...

Fig 1: Chest CT of the hospital admission showing small sparse focal lesions in the...

Fig 2: 2nd chest CT performed 18 days after the first examination: extensive areas...

Fig 3: New chest CT, after 13 days of mechanical ventilation, which showed...

Fig 4: Coronal reconstructions demonstrating pneumomediastinum (green arrows) in...

Fig 5: First Chest CT: Bilateral, diffuse, predominantly peripheral, ground glass...

Fig 6: 2nd chest CT: 18 days after admission. Marked subcutaneous emphysema,...

Fig 7: Axial CT: The same case of the previous figure, showing the areas the areas of...

Fig 8: Coronal reconstructions demonstrating the extension of subcutaneous emphysema...

Fig 9: Coronal reconstructions: Pneumomediastinum and showing also pneumoperitoneum.

Fig 10: First Chest CT: extensive areas of attenuation in ground glass and with...

Fig 11: Chest X-rays on April 6, 2020 without evidence of pneumomediastinum....

Fig 12: Axial chest CT: pneumomediastinum presenting air dissecting along the aortic...

Fig 13: Coronal reconstructions demonstrating extensive subcutaneous emphysema in the...

Fig 14: First Chest CT: extensive areas of crazy-paving patterns with foci of...

Fig 15: Large subcutaneous emphysema in the neck and chest dissecting the muscle...

Fig 16: Coronal reconstructions demonstrating large subcutaneous emphysema in the neck...

Fig 17: Sagittal reconstructions demonstrating the extent of subcutaneous emphysema,...

Fig 18: Initial CT. Ground area of ground glass in the upper right lobe. Small foci of...

Fig 19: Chest x-ray 2/10/2020 : diffuse interstitial infiltrate, with most evident...

Fig 20: 2nd Chest CT performed 4 days after showed great extension of subcutaneous...

Fig 21: Extensive subcutaneous emphysema, showing the air dissecting the muscle fibers...

Fig 22: Initial chest CT showed diffuse crazy-paving patterns in the lungs, with more...

Fig 23: 2nd Chest CT (14 days later): Increased extension of the parenchymal...

Fig 24: Coronal reconstructions: Emphysema in soft parts (green arrows). Small...

Fig 25: Initial chest CT: opacities in ground glass, confluent, forming focal...

Fig 26: 2nd Chest CT (4 days later): extensive subcutaneous emphysema protruding the...

Fig 27: 2nd Chest CT: great subcutaneous emphysema on the right, in addition to...

Fig 28: Coronal reconstructions demonstrating the extension of subcutaneous emphysema...

Fig 29: Extensive subcutaneous emphysema in the cervical and thoracic regions...

Fig 30: Coronal reconstructions demonstrating the extension of subcutaneous emphysema...

Fig 31: Chest CT: subcutaneous emphysema, pneumomediastinum, pulmonary opacities in...