Incidence and risk factors for pneumomediastinum in COVID-19 patients in the intensive care unit

• Published in: Interactive cardiovascular and thoracic surgery 2022-01, Vol.34 (2), p.236-244
• Main Authors: Özdemir, Servet, Bilgi, Deniz Özel, Hergünsel, Gülsüm Oya, Çitak, Necati
• Format: Article
• Language: English
• Subjects: COVID-19; Humans; Incidence; Intensive Care Units; Mediastinal Emphysema - diagnosis; Mediastinal Emphysema - epidemiology; Mediastinal Emphysema - therapy; Respiration, Artificial - adverse effects; Retrospective Studies; Risk Factors; SARS-CoV-2; Thoracic
• ISSN: 1569-9285; 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivab258

Abstract   OBJECTIVES The incidence of pneumomediastinum (PNMD), its causes of development and its effect on prognosis in the coronavirus disease 2019 (COVID-19) are not clear. METHODS Between March 2020 and December 2020, 427 patients with real-time reverse transcriptase-polymerase chain reaction-confirmed COVID-19 admitted to the intensive care unit were analysed retrospectively. Using receiver operating characteristic analysis, the area under the curve (AUC) for initial invasive mechanical ventilation (MV) variables such as initial peak inspiratory pressure (PIP), PaO2/FiO2 (P/F ratio), tidal volume, compliance and positive end-expiratory pressure was evaluated regarding PNMD development. RESULTS The incidence of PNMD was 5.6% (n = 24). PNMD development rate was 2.7% in non-invasive MV and 6.2% in MV [odds ratio (OR) 2.352, 95% confidence interval (CI) 0.541–10.232; P = 0.400]. In the multivariate analysis, the independent risk factors affecting the development of PNMD were PIP (OR 1.238, 95% CI 1.091–1.378; P