Prone positioning in severe acute respiratory distress syndrome. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968–2016. Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome. the Acute Respiratory Distress Syndrome Network. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. Pneumothorax in the intensive care unit: Incidence, risk factors, and outcome. The funders had no role in the design of the study in the collection, analyses, or interpretation of data in the writing of the manuscript or in the decision to publish the results. The authors declare no conflict of interest. These finding suggest that differences in air leak incidences between studies could have been driven by ventilator settings. One salient finding was that the median peak airway pressures and PEEPs in our cohort were lower than what was reported in the previous studies with a higher incidence of air leaks. In our cohort, the VT, PEEP and Pmax were within widely accepted safety limits, and prone position was also heavily used. Indeed, ventilation with a low VT or low airway pressures may prevent gross barotrauma in patients with ARDS prone ventilation may also have a protective effect, as it could facilitate the use of lower airway pressures. Incidences of air leaks may be driven, at least in part, by how ventilators are set. There were no other differences in ventilator settings between patients with air leaks and patients without air leaks in our cohort. This could mean that the lungs of patients who developed an air leak were more affected than those of patients who did not develop this complication. Patients with an air leak in our cohort were ventilated with a higher median of FiO 2 than patients without an air leak. One meta-analysis, including 15 studies, suggests a linear relation between disease severity and the development of air leaks. Even the preferred location of pneumothoraxes was similar to what was reported in previous studies. The distribution of types of air leaks, however, was similar to what was reported before, with pneumothorax being the most common air leak. This difference cannot be explained by differences in patient selection or by the exclusion of patients from our study, e.g., because of a missing CXR or chest CT scan. Indeed, the reported incidences in previous studies detailing a higher rate of incidence varied from 9.6% to as high as 24.4%, with a pooled incidence of 15.6%. In fact, only one study reported a lower incidence. The proportion of patients with air leaks in our study was remarkably lower than the reported incidences in nearly all published studies. The findings of our study are not in line with previous reports on air leaks in patients with acute hypoxemic respiratory failure due to COVID-19. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era. ![]() The median first day of the presence of an air leak was 18 (2–21) days after arrival in the ICU and 18 (9–22)days after the start of invasive ventilation. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors there was a median of three (2–5) chest radiographs and a median of one (1–2) chest CT scans per patient. ![]() We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure.
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