Spontaneous pneumomediastinum: a surrogate of P-SILI in critically ill COVID-19 patients
Alexandre Elabbadi,
Tomas Urbina,
Enora Berti,
Damien Contou,
Gaëtan Plantefève,
Quintana Soulier,
Audrey Milon,
Guillaume Carteaux,
Guillaume Voiriot,
Muriel Fartoukh,
Aude Gibelin
Affiliations
Alexandre Elabbadi
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université
Tomas Urbina
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université
Enora Berti
Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor
Damien Contou
Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy
Gaëtan Plantefève
Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy
Quintana Soulier
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université
Audrey Milon
Assistance Publique – Hôpitaux de Paris, Service de Radiologie, Hôpital Tenon, Sorbonne Université
Guillaume Carteaux
Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor
Guillaume Voiriot
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université
Muriel Fartoukh
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université
Aude Gibelin
Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université
Abstract Spontaneous pneumomediastinum (SP) has been described early during the COVID-19 pandemic in large series of patients with severe pneumonia, but most patients were receiving invasive mechanical ventilation (IMV) at the time of SP diagnosis. In this retrospective multicenter observational study, we aimed at describing the prevalence and outcomes of SP during severe COVID-19 with pneumonia before any IMV, to rule out mechanisms induced by IMV in the development of pneumomediastinum. Among 549 patients, 21 patients (4%) developed a SP while receiving non-invasive respiratory support, after a median of 6 days [4–12] from ICU admission. The proportion of patients requiring IMV was similar. However, the time to tracheal intubation was longer in patients with SP (6 days [5–13] vs. 2 days [1–4]; P = 0.00002), with a higher first-line use of non-invasive ventilation (n = 11; 52% vs. n = 150; 28%; P = 0.02). The 21 patients who developed a SP had persisting signs of severe lung disease and respiratory failure with lower ROX index between ICU admission and occurrence of SP (3.94 [3.15–5.55] at admission vs. 3.25 [2.73–4.02] the day preceding SP; P = 0.1), which may underline potential indirect signals of Patient-self inflicted lung injury (P-SILI). In this series of critically ill COVID-19 patients, the prevalence of SP without IMV was not uncommon, affecting 4% of patients. They received more often vasopressors and had a longer ICU length of stay, as compared with their counterparts. One pathophysiological mechanism may potentially be carried out by P-SILI related to a prolonged respiratory failure, as underlined by a delayed use of IMV and the evolution of the ROX index between ICU admission and the day preceding SP.
