Coronavirus Associated Pneumomediastinum and Pneumothorax

NCT ID: NCT04897152

Last Updated: 2022-04-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

241 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-08-15

Study Completion Date

2021-08-31

Brief Summary

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Spontaneous pneumomediastinum (PMS) is defined as free air within the mediastinum. Spontaneous pneumothorax (PNX) consists of the presence of air inside the pleural space. PMS and PNX may sometimes occur secondly to an underlying pathology, or deriving from a sudden increase in intra-alveolar pressure such as functional alteration such as airway hyperactivity, Valsalva maneuver, cough, barotrauma, and/or volutrauma with consequent rupture of the alveoli and subsequent leakage of air into the mediastinum due to the Macklin effect. The escaping air can then spread inside the pericardium, the peritoneum, the muscles, and subcutaneous tissues, hence causing subcutaneous emphysema.

PMS and PNX are rare complications of several lung infections such as Pneumocystis Jirovecii pneumonia, tuberculosis, bacterial necrotizing pneumonia, and herpes pneumonia.

However, an increasing number of PMS and PNX has been described in patients with SARS-CoV2 interstitial pneumonia. PMS and PNX can either present as the onset manifestation of COVID-19 disease, or occur as complications of non-invasive and/or invasive ventilation, or following to cystic and/or fibrotic evolution of the pathology.

The frequency of PMS and PNX during COVID-19 is not well defined, as the available data are limited to case collections and single reports. According to currently available scientific literature, PNX in COVID-19 occurs with frequency rates of 1-3%, up to 6% in patients undergoing non-invasive ventilation (NIV) and mechanical artificial ventilation (VAM). In McGuinness's analysis, which compared the complications of barotrauma in patients with acute respiratory distress syndrome (ARDS) in VAM, PNX and PMS occurred with frequency rates of 9% and 10%, respectively, while in non-COVID-19 population, PNX and PMS frequency rates were 12% and 3%, respectively.

Detailed Description

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Conditions

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Pneumothorax Pneumomediastinum COVID-19 Pneumonia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* Patients 18 years of age or older hospitalized with SARS-COV2 infection

Exclusion Criteria

* Failure to obtain clinical or radiological information about the case
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Sanitaria-Universitaria Integrata di Udine

OTHER

Sponsor Role lead

Responsible Party

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Luigi Vetrugno

Clinical Professor in Anesthesiology and Intensive Care

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Policlinico S.Orsola-Malpighi, Pneumologia e Terapia Intensiva Respiratoria

Bologna, , Italy

Site Status

Policlinico S.Orsola-Malpighi, U.O Malattie Infettive

Bologna, , Italy

Site Status

Azienda Ospedaliero-Universitaria V.Emanuele Ferrarotto, S.bambino, Malattie Infettive

Catania, , Italy

Site Status

Azienda Ospedaliero-Universitaria V.Emanuele Ferrarotto, S.bambino, U.O.C. di Malattie Infettive

Catania, , Italy

Site Status

Azienda Ospedaliera S.Croce e Carle Cuneo, SC Malattie Infettive e tropicali,

Cuneo, , Italy

Site Status

Ospedale Policlinico San Martino-IRCCS, Clinica di Malattie Infettive e Tropicali

Genova, , Italy

Site Status

Fondazione IRCCS, Ca Granda Ospedale Maggiore Policlinico, UOC, Malattie Infettive

Milan, , Italy

Site Status

Ospedale dei colli, Malattie Infettive ed Urgenze Infettivologiche,

Napoli, , Italy

Site Status

Azienda Ospedaliera di Padova, S.C di Fisiopatologia respiratoria,

Padua, , Italy

Site Status

Unità Operativa Complessa Istituto di Anestesia e Rianimazione dell'Azienda Ospedale-Università di Padova,

Padua, , Italy

Site Status

Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo, UOC Anestesia Rianimazione con Terapia Intensiva Polivalente e del Dolore

Palermo, , Italy

Site Status

Azienda Ospedaliero-Universitaria di Parma, Clinica Pneumologica

Parma, , Italy

Site Status

Azienda Ospedaliera Perugia, Malattie Infettive

Perugia, , Italy

Site Status

Azienda USL Toscana Ovest, Ospedale Felice Lotti SOC Medicina Interna

Pontedera, , Italy

Site Status

Azienda Sanitaria Universitaria Friuli Occidentale, S.C Pneumologia

Pordenone, , Italy

Site Status

AOU Città della Salute e Scienza, SC Malattie Infettive

Torino, , Italy

Site Status

Azienda Ospedaliera Ordine Mauriziano S.C. Pneumologia e Unità di Terapia Semi Intensiva Respiratoria

Torino, , Italy

Site Status

Ospedale Cardinal Massaia, SC Malattie Infettive

Torino, , Italy

Site Status

Azienda Sanitaria Universitaria Giuliano Isontina, S.C Pneumologia

Trieste, , Italy

Site Status

Anesthesiology and Intensive Care Clinic - Department of Medicine - ASUIUD

Udine, , Italy

Site Status

Azienda ospedaliero universitaria Friuli Centrale, Anestesia e Rianimazione 1

Udine, , Italy

Site Status

Azienda ospedaliero universitaria Friuli Centrale, Anestesia e Rianimazione 2

Udine, , Italy

Site Status

Azienda ospedaliero universitaria Friuli Centrale, Clinica di Anestesia e Rianimazione

Udine, , Italy

Site Status

Azienda Ospedaliero Universitaria Friuli Centrale, Malattie infettive

Udine, , Italy

Site Status

Azienda Ospedaliero Universitaria Friuli Centrale, Pneumologia

Udine, , Italy

Site Status

Azienda Sanitaria locale di Vercelli, Malattie infettive

Vercelli, , Italy

Site Status

Università di Verona, Clinica delle Malattie Infettive e Tropicali

Verona, , Italy

Site Status

Countries

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Italy

References

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Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med. 1984 Jul;144(7):1447-53.

Reference Type BACKGROUND
PMID: 6375617 (View on PubMed)

Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med. 2020 Aug 20;27(5):taaa062. doi: 10.1093/jtm/taaa062.

Reference Type BACKGROUND
PMID: 32330274 (View on PubMed)

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7. Epub 2020 Jan 30.

Reference Type BACKGROUND
PMID: 32007143 (View on PubMed)

Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, Xiao W, Yao S, Mei W, Chen X, Luo A, Sun L, Cook T, Behringer E, Huitink JM, Wong DT, Lane-Fall M, McNarry AF, McGuire B, Higgs A, Shah A, Patel A, Zuo M, Ma W, Xue Z, Zhang LM, Li W, Wang Y, Hagberg C, O'Sullivan EP, Fleisher LA, Wei H; collaborators. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth. 2020 Jul;125(1):e28-e37. doi: 10.1016/j.bja.2020.03.026. Epub 2020 Apr 10.

Reference Type BACKGROUND
PMID: 32312571 (View on PubMed)

McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, Thomas KM, Moore WH. Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 2020 Nov;297(2):E252-E262. doi: 10.1148/radiol.2020202352. Epub 2020 Jul 2.

Reference Type BACKGROUND
PMID: 32614258 (View on PubMed)

Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V; Italian COVI-MIX Study Group; De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology. 2023 Nov-Dec;29(6):457-468. doi: 10.1016/j.pulmoe.2022.11.002. Epub 2022 Nov 24.

Reference Type DERIVED
PMID: 36669936 (View on PubMed)

Other Identifiers

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COVI-MIX

Identifier Type: -

Identifier Source: org_study_id

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