Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak
Pietro Andrea Bonaffini,
Francesco Stanco,
Ludovico Dulcetta,
Giancarla Poli,
Paolo Brambilla,
Paolo Marra,
Clarissa Valle,
Ferdinando Luca Lorini,
Mirko Mazzoleni,
Beatrice Sonzogni,
Fabio Previdi,
Sandro Sironi
Affiliations
Pietro Andrea Bonaffini
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Francesco Stanco
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Ludovico Dulcetta
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Giancarla Poli
Unit of Intensive Care and Anesthesia 2, Papa Giovanni XXIII Hospital, Piazza OMS, 24127 Bergamo, BG, Italy
Paolo Brambilla
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Paolo Marra
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Clarissa Valle
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Ferdinando Luca Lorini
School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
Mirko Mazzoleni
Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
Beatrice Sonzogni
Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
Fabio Previdi
Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
Sandro Sironi
Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.
