自发性气胸作为Covid-19的并发症

S. Podder, N. Donthi, E. Ekanem, M. Desai
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Data on demographic, comorbidities, inflammatory markers, ventilatory mode and treatment methods were collected. Findings are displayed in Table 1. RESULTS The median length of stay was 18.5 days with the diagnosis of pneumothorax made between days 1 and 30 of hospitalization. All pneumothoraces were diagnosed on chest x-ray, with the most common reason for obtaining chest imaging being respiratory distress and worsening hypoxia. 10 patients developed left-sided pneumothorax, 11 patients developed right-sided pneumothorax and 1 patient developed bilateral pneumothoraces. 8 out of the 22 patients (36%) died, whereas the crude mortality of all patients admitted with Covid-19 during this time span was 15.8%. The median age of our cohort was 60 years and 82% were male. Majority of the patients were Latino. The most common comorbidities in this cohort included hypertension (52%) and diabetes (32%). 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摘要

Covid-19与包括气胸在内的多器官并发症有关。主要是病例报告和小病例系列的回顾性研究表明,1-2%的Covid-19患者可能出现气胸。这种潜在的致命并发症被认为更可能发生在机械通气患者和有潜在肺部疾病的患者中。我们的目的是描述因Covid-19住院并发生气胸的患者的危险因素。方法:对2020年3月1日至2020年5月21日期间在Inova卫生系统内5家医院住院的COVID-19患者进行回顾性图表分析。在1619名Covid-19住院患者中,22名患者(1.4%)出现气胸。收集人口统计学、合并症、炎症标志物、通气方式和治疗方法等数据。结果如表1所示。结果中位住院时间为18.5天,在住院第1天至第30天诊断为气胸。所有气胸均在胸片上诊断,最常见的胸部影像学原因是呼吸窘迫和缺氧恶化。左侧气胸10例,右侧气胸11例,双侧气胸1例。22名患者中有8名(36%)死亡,而在此期间入院的所有Covid-19患者的粗死亡率为15.8%。我们队列的中位年龄为60岁,82%为男性。大多数患者是拉丁裔。该队列中最常见的合并症包括高血压(52%)和糖尿病(32%)。值得注意的是,只有19%的患者有潜在的肺部病理,如慢性阻塞性肺疾病(COPD)和哮喘。只有不到一半的气胸患者接受了通气治疗。16例(73%)患者放置胸管进行治疗。结论Covid-19肺炎患者明显的炎症反应、纤维化和需要正压通气可能是气胸发生的重要因素。与大多数气胸病例不同,Covid-19患者的病因似乎是多因素的,与高通气设置没有直接关系。在我们的患者中,许多患者在诊断时使用鼻插管,这一事实支持了这一点。及时诊断和治疗对于降低这一人群的发病率和死亡率至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Spontaneous Pneumothorax as a Complication of Covid-19
RATIONALE Covid-19 has been associated with multi-organ complications, including pneumothoraces. Retrospective studies, which have primarily been case reports and small case series, suggest that pneumothoraces may occur in 1-2% of patients with Covid-19. This potentially lethal complication is thought to more likely occur in mechanically ventilated patients and those with underlying lung disease. Our aim is to characterize the risk factor in patients hospitalized for Covid-19 who developed pneumothoraces. METHODS We conducted a retrospective chart review of patients with COVID-19 admitted at 5 hospitals within the Inova Health System between March 1, 2020 and May 21, 2020. Out of the 1619 hospitalized patients with Covid-19, 22 patients (1.4%) developed pneumothorax. Data on demographic, comorbidities, inflammatory markers, ventilatory mode and treatment methods were collected. Findings are displayed in Table 1. RESULTS The median length of stay was 18.5 days with the diagnosis of pneumothorax made between days 1 and 30 of hospitalization. All pneumothoraces were diagnosed on chest x-ray, with the most common reason for obtaining chest imaging being respiratory distress and worsening hypoxia. 10 patients developed left-sided pneumothorax, 11 patients developed right-sided pneumothorax and 1 patient developed bilateral pneumothoraces. 8 out of the 22 patients (36%) died, whereas the crude mortality of all patients admitted with Covid-19 during this time span was 15.8%. The median age of our cohort was 60 years and 82% were male. Majority of the patients were Latino. The most common comorbidities in this cohort included hypertension (52%) and diabetes (32%). Notably, only 19% of the patients had underlying lung pathology such as chronic obstructive pulmonary disease (COPD) and asthma. Less than half of the patients who had pneumothoraces were ventilated. 16 (73%) patients had chest tubes placed for treatment. CONCLUSION The marked inflammatory response, fibrosis, and need for positive pressure ventilation in Covid-19 pneumonia are likely contributory to the development of pneumothorax. Unlike most cases of pneumothoraces, the etiology in patients with Covid-19 appears to be multifactorial and not directly associated with high vent settings. This is supported by the fact that many patients in our patients were on nasal cannula at time of diagnosis. Prompt diagnosis and treatment are crucial to mitigate morbidity and mortality in this population.
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