Barotravma Saptanan COVID-19 İlişkili ARDS Hastalarının Radyolojik Özellikleri ve Sonlanımları

Year 2023, , 35 - 40, 16.03.2023

Kamil Gonderen , Mehmet Yıldırım , Fatma Yıldırım , Meltem Şimşek

https://doi.org/10.31832/smj.1151067

Abstract

Giriş: Spontan veya pozitif basınçlı ventilasyona bağlı gelişen barotravmanın Coronavirus 2019 (COVID-19) hastalarında diğer hastalara göre daha sık olduğu bildirilmiştir. Bu çalışmada yoğun bakım ünitesinde; invaziv mekanik ventilasyon (IMV), non-invaziv mekanik ventilasyon (NIMV) ya da yüksek akışlı nazal oksijen tedavisi (YANO) alan COVID-19 ilişkili ARDS hastalarında barotravma insidansının tespit edilmesi ve bu hastaların klinik, radyolojik özellikleri ve sonlanımlarının ortaya koyulması amaçlanmıştır.
Gereç ve Yöntemler: Bu iki merkezli çalışmada, yoğun bakım ünitesinde COVID-19 ilişkili ARDS nedeniyle izlenen ve IMV, NIMV ve YANO tedavisi alan hastaların özellikleri ve sonlanımları retrospektif olarak araştırıldı. Barotravma bulguları pnomotoraks, pnomomediastinum, pnomoperikardiyum ve subkutan amfizem olarak belirlendi.
Bulgular: Toplam 660 hastanın 29 (%4,4) tanesinde barotravma tespit edildi. Barotavma izlenen 29 hastanın 19 (%65,5) tanesinde pnömotoraks, 5 (%17,2) tanesinde pnömomediastinum ve 5 (%17,2) tanesinde subkutan amfizem mevcuttu. Onsekiz (%62,1) hastaya tedavi amaçlı tup torakostomi uygulanırken, 11 (%37,9) hasta konservatif izlendi. Barotravma saptandığı anda 17 (%58,6) hasta IMV, 11 (%37,9) hasta NIMV ve 1 (%3,4) hasta YANO almaktaydı. Barotravma izlenen 29 hastanın ortalama yoğun bakım yatış süresi 15,3±10,8 gün idi ve 19 (%65,5) hasta vefat etti.
Sonuç: Barotravma, COVID-19 ilişkili ARDS hastalarında nadir olmayan ve yoğun bakım yatış süresi ve mortaliteyi artırabilecek bir durum olarak tespit edildi.

Keywords

COVID-19, ARDS, barotravma, yoğun bakım

Radiological Features and Outcomes of COVID-19 Associated ARDS Patients with Barotrauma

Abstract

Objective: Barotrauma developing spontaneously or associated with positive pressure ventilation applied as respiratory support therapy is reported more frequently in patients with novel coronavirus 2019 (COVID-19). In this study, we aimed to determine the incidence of barotrauma in critically-ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS) who received invasive mechanical ventilation (IMV), (non-invasive mechanical ventilation NIMV) or high flow nasal oxygen therapy (HFNO) and reveal clinical features, radiological findings and outcomes of these patients.
Materials and Methods: In this two-center study, the frequency and clinical characteristics of patients who developed barotrauma while being followed up in the ICU due to COVID-19 were retrospectively investigated.
Results: Barotrauma was detected in 29 (4.4%) of 660 patients. Nineteen (65.5%) patients developed pneumothorax, 5 (17.2%) patients developed pneumomediastinum, 5 (17.2%) patients developed subcutaneous emphysema; 18 (62.1%) patients underwent tube thoracostomy, 11 (37.9%) patients were followed conservatively. When barotrauma developed, 17 (58.6%) patients were receiving IMV, 11 (37.9%) patients were receiving NIMV, and 1 (3.4%) patient was receiving HFNO. The mean length of stay in the ICU was 15.3±10.8 days, 19 (65.5%) of the patients died.
Conclusion: Barotrauma is not uncommon in COVID-19 ARDS patients; It is a complication that can increase mortality and length of stay in ICU.

Keywords

COVID-19, ARDS, barotrauma, intensive care unit

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