Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

被引：25

作者：

Melhorn, James ^{[1
,2
,3
]}

Achaiah, Andrew ^{[3
,4
]}

Conway, Francesca M. ^{[5
]}

Thompson, Elizabeth M. F. ^{[6
]}

Skyllberg, Erik W. ^{[7
]}

Durrant, Joseph ^{[7
]}

Hasan, Neda A. ^{[8
]}

Madani, Yasser ^{[8
]}

Naran, Prasheena ^{[9
]}

Vijayakumar, Bavithra ^{[5
,10
]}

Tate, Matthew J. ^{[11
]}

Trevelyan, Gareth E. ^{[12
]}

Zaki, Irfan ^{[12
]}

Doig, Catherine A. ^{[13
]}

Lynch, Geraldine ^{[14
]}

Warwick, Gill ^{[15
]}

Aujayeb, Avinash ^{[16
]}

Jackson, Karl A. ^{[16
]}

Iftikhar, Hina ^{[17
]}

Noble, Jonathan H. ^{[17
]}

Ng, Anthony Y. K. C. ^{[18
]}

Nugent, Mark ^{[19
]}

Evans, Philip J. ^{[19
]}

Hastings, Robert A. ^{[20
]}

Bellenberg, Harry R. ^{[20
]}

Lawrence, Hannah ^{[21
]}

Saville, Rachel L. ^{[21
]}

Johl, Nikolas T. ^{[22
]}

Grey, Adam N. ^{[22
]}

Ellis, Huw C. ^{[23
]}

Chen, Cheng ^{[23
]}

Jones, Thomas L. ^{[24
]}

Maddekar, Nadeem ^{[25
]}

Khan, Shahul Leyakathali ^{[25
]}

Muhammad, Ambreen Iqbal ^{[26
]}

Ghani, Hakim ^{[26
]}

Myint, Yadee Maung Maung ^{[26
]}

Rafique, Cecillia ^{[27
]}

Pippard, Benjamin J. ^{[27
]}

Irving, Benjamin R. H. ^{[28
]}

Ali, Fawad ^{[29
]}

Asimba, Viola H. ^{[30
]}

Azam, Aqeem ^{[31
]}

Barton, Eleanor C. ^{[32
]}

Bhatnagar, Malvika ^{[33
]}

Blackburn, Matthew P. ^{[34
,35
]}

Millington, Kate J. ^{[36
]}

Budhram, Nicholas J. ^{[36
]}

Bunclark, Katherine L. ^{[37
]}

Sapkal, Toshit P. ^{[37
]}

机构：

[1] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Med, Oxford, England

[2] Oxford Biomed Res Ctr, Natl Inst Hlth Res NIHR, Oxford, England

[3] Oxford Univ Hosp NHS Fdn Trust, John Radcliffe Hosp, Oxford, England

[4] Univ Oxford, Weatherall Inst Mol Med, MRC, Human Immunol Unit, Oxford, England

[5] Natl Heart & Lung Inst, Royal Brompton Hosp, London, England

[6] Barts Hlth NHS Trust, St Bartholomews Hosp, London, England

[7] Barts Hlth NHS Trust, Newham Univ Hosp, London, England

[8] Frimley Hlth NHS Fdn Trust, Wexham Pk Hosp, Slough, Berks, England

[9] Royal Free London NHS Fdn Trust, Royal Free Hosp, London, England

[10] Imperial Coll London, Natl Heart & Lung Inst, Chelsea & Westminster Hosp, London, England

[11] NHS Greater Glasgow & Clyde, Queen Elizabeth Univ Hosp, Glasgow, Lanark, Scotland

[12] Royal Berkshire NHS Fdn Trust, Royal Berkshire Hosp, Reading, Berks, England

[13] Mid & South Essex NHS Fdn Trust, Southend Univ Hosp, Southend On Sea, England

[14] Cwm Taf Morgannwg Univ Hlth Board, Prince Wales Hosp, Bridgend, Wales

[15] Aneurin Bevan Hlth Board, Royal Gwent Hosp, Newport, Gwent, Wales

[16] Northumbria Healthcare NHS Fdn Trust, Northumbria Specialist Emergency Care Hosp, Cramlington, England

[17] Gloucestershire Hosp NHS Fdn Trust, Gloucester Royal Hosp, Gloucester, England

[18] Cambridge Univ Hosp NHS Trust, Addenbrookes Hosp, Cambridge, England

[19] Hywel Dda Univ Hlth Board, Glangwilli Gen Hosp, Carmarthen, Dyfed, Wales

[20] Royal Free London NHS Fdn Trust, Barnet Gen Hosp, London, England

[21] Univ Hosp Derby & Burton NHS Fdn Trust, Royal Derby Hosp, Derby, England

[22] Cardiff & Vale Univ Hlth Board, Univ Hosp Wales, Cardiff, Wales

[23] Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hosp, Stoke Mandeville, England

[24] Hampshire Hosp NHS Fdn Trust, Basingstoke & North Hampshire Hosp, Basingstoke, Hants, England

[25] Univ Hosp North Midlands NHS Trust, Royal Stoke Univ Hosp, Stoke, England

[26] West Hertfordshire Hosp NHS Trust, Watford Gen Hosp, Watford, England

[27] North Tees & Hartlepool NHS Fdn Trust, Univ Hosp North Tees, Hartlepool, England

[28] Portsmouth Hosp Univ NHS Trust, Queen Alexandra Hosp, Portsmouth, Hants, England

[29] Bedfordshire Hosp NHS Fdn Trust, Bedford Hosp, Bedford, England

[30] Nottingham Univ Hosp NHS Trust, Nottingham Univ Hosp, Nottingham, England

[31] East Lancashire Hosp NHS Trust, Royal Blackburn Teaching Hosp, Blackburn, Lancs, England

[32] Aneurin Bevan Hlth Board, Grange Univ Hosp, Cwmbran, Wales

[33] Cty Durham & Darlington NHS Fdn Trust, Darlington Mem Hosp, Durham, England

[34] Southport & Ormskirk Dist Gen Hosp, Southport, Qld, Australia

[35] Ormskirk Hosp NHS Trust, Southport, Qld, Australia

[36] Great Western Hosp NHS Fdn Trust, Great Western Hosp, Swindon, Wilts, England

[37] Norfolk & Norwich Univ Hosp NHS Fdn Trust, Norwich & Norfolk Univ Hosp, Norwich, Norfolk, England

[38] Royal United Hosp Bath NHS Fdn Trust, Royal United Hosp Bath, Bath, Avon, England

[39] Cwm Taf Univ Hlth Board, Royal Glamorgan Hosp, Llantrisant, Wales

[40] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Manchester, Lancs, England

[41] Princess Alexandra Hosp NHS Trust, Princess Alexandra Hosp, Harlow, Essex, England

[42] Bedfordshire Hosp NHS Fdn Trust, Luton & Dunstable Univ Hosp, Luton, Beds, England

[43] Kettering Gen Hosp NHS Fdn Trust, Kettering Gen Hosp, Kettering, England

[44] Univ Hosp Coventry & Warwickshire NHS Trust, Univ Hosp, Coventry, W Midlands, England

[45] East & North Hertfordshire NHS Trust Stevenage, Lister Hosp, Stevenage, Herts, England

[46] Somerset NHS Fdn Trust, Musgrove Pk Hosp, Taunton, Somerset, England

[47] Barts Hlth NHS Trust, Whipps Cross Hosp, London, England

[48] Aneurin Bevan Univ Hlth Board, Neville Hall Hosp, Abergavenny, Wales

[49] Royal Devon & Exeter NHS Fdn Trust, Royal Devon & Exeter Hosp, Exeter, Devon, England

[50] Royal Cornwall Hosp NHS Trust, Royal Cornwall Hosp, Truro, England

来源：

EUROPEAN RESPIRATORY JOURNAL | 2022年 / 60卷 / 03期

关键词：

EMPHYSEMA; EPIDEMIC;

D O I：

10.1183/13993003.02522-2021

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome. Methods A structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicited via respiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality. Results 377 cases of PTM in COVTD-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM at the time of diagnosis and thereafter (p<0.001), along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality. Conclusions PTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.

引用

页数：11

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