Abstract :
Air leak syndrome manifesting as pneumomediastinum (PM), pneumothorax (PNX) or subcutaneous emphysema (SCE) has been reported in COVID-19 patients with increasing frequency and with varying outcomes. We report a series of eight cases of PM or SCE from 1 April to May 31, 2021, among COVID-19 patients admitted in our ICU. All the patients had severe hypoxemia (PaO2/FiO2 ratio ?100) and were on noninvasive ventilation when the air leak was detected except one. PM/SCE was observed mostly on the 3 to 5 day after instituting positive pressure ventilation. High respiratory drive with mean tidal volumes in the range of 6 to 10ml/kg predicted body weight was observed in these patients. Mean inspiratory pressure (Pressure support positive end expiratory pressure) and mean positive end expiratory pressure delivered by the ventilator ranged between 11 to 21 and 5 to 12 cm HO respectively. Outcomes varied with four deaths, four patients requiring intubation, two patients requiring chest drainage and four patients showing overall improvement out of the total eight patients with air leak.
Key Messages: 1.Air leak syndrome is not rare in COVID-19 with reported incidence of 10-14%; 2. Spontaneous noninvasive ventilation in patients with high respiratory drive and large fluctuations in tidal volumes seems to be a risk factor for air leak in patients with severe lung involvement; 3. A conservative approach without intercostal drainage seems to be acceptable in the absence of pneumothorax; 4. Prognosis is varied depending on the underlying disease and not always catastrophic.
Keyword :
Air leak, Pneumomediastinum, COVID19, Pneumothorax, Subcutaneous emphysema, Noninvasive, Spontaneous ventilation