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Effect of Pneumothorax and Pneumomediastinum on Survival in Patients with Covid-19 Ards in the Icu
Critical Care Medicine ; 51(1 Supplement):554, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190671
ABSTRACT

INTRODUCTION:

There is a wide range in the reported incidence of pneumothorax (PTX) and pneumomediastinum (PMN) in patients with coronavirus disease 2019 (COVID-19). PTX alone and PTX/PMN combined has also been associated with higher mortality in patients with COVID-19 related acute respiratory distress syndrome (ARDS), however, current data regarding outcomes or predictors of PTX and PMN in COVID-19 ARDS is limited. The purpose of this study was to determine if the incidence of PTX/PMN in a large cohort with COVID-19 related respiratory failure was associated with mortality. Further, we looked to determine which clinical factors or ventilator management strategies may have impacted mortality in underserved patient population with PTX. METHOD(S) We conducted a retrospective analysis of data from a single center COVID-19 intensive care unit of an urban tertiary safety net hospital including all adult patients admitted with COVID-19 associated ARDS requiring mechanical ventilation between March 2020 and January 2021. Following identification of a cohort with radiographic evidence of PTX and/or PMN, demographics, ventilator data, radiographic data, position, information regarding chest tube and sedation management and outcome data were obtained from the electronic medical record. RESULT(S) Among 502 patients admitted to the ICU with COVID-19 related ARDS, PTX was identified in 103/ 502 (20.5%), predominantly affecting Hispanic (88%) and male (66%) patients. Thirty-four patients had PMN (18.7%) alone. Of patients with documented PTX, 60 (50.8%) had preceding or co-morbid PMN. PTX with/without PMN was associated with increased mortality (OR 2.19, p=0.0027) even after adjustment for ventilator days. There was no significant association between PMN alone and mortality (OR 0.82, p=0.60). Conservative management without tube thoracostomy was rarely possible (18.4% of PTX). Time to development of PTX was not associated with mortality, but PTX was associated with longer survival times (HR 2.10;p< 0.001). CONCLUSION(S) There is a high incidence of PTX/PMN in critically ill patients with COVID-19. PTX, but not PMN alone, is associated with higher mortality in ICU patients.
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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo experimental / Estudo prognóstico Idioma: Inglês Revista: Critical Care Medicine Ano de publicação: 2023 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo experimental / Estudo prognóstico Idioma: Inglês Revista: Critical Care Medicine Ano de publicação: 2023 Tipo de documento: Artigo