Abstract：
BACKGROUND: Patients with severe respiratory failure due to COVID-19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V-V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID-19 and acute respiratory failure due to spontaneous PM.
METHODS: This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID-19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V-V ECMO support (V-V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission.
RESULTS: Twenty-two patients were included in this study (invasive ventilation group: 13 [59%]; V-V ECMO group: 9 [41%]). The V-V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12-0.97], p = 0.04). Five (38%) patients in the V-V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V-V ECMO support within 30 days from ICU admission. Three (33%) patients in the V-V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48-45.3], p = 0.18).
CONCLUSIONS: Preliminary data suggest that V-V ECMO without invasive ventilation may improve survival in COVID-19-related acute respiratory failure due to spontaneous PM. The study\'s retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution.
METHODS: This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID-19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V-V ECMO support (V-V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission.
RESULTS: Twenty-two patients were included in this study (invasive ventilation group: 13 [59%]; V-V ECMO group: 9 [41%]). The V-V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12-0.97], p = 0.04). Five (38%) patients in the V-V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V-V ECMO support within 30 days from ICU admission. Three (33%) patients in the V-V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48-45.3], p = 0.18).
CONCLUSIONS: Preliminary data suggest that V-V ECMO without invasive ventilation may improve survival in COVID-19-related acute respiratory failure due to spontaneous PM. The study\'s retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution.
摘要：
背景：未接受机械通气的COVID-19引起的严重呼吸衰竭患者在并发自发性纵隔气肿（PM）时可能会出现严重的低氧血症。这些患者可能会受到有创通气的伤害。或者，可以应用静脉-静脉（V-V）体外膜氧合（ECMO）。我们报告了V-VECMO和有创通气作为COVID-19和自发性PM引起的急性呼吸衰竭患者的初始高级呼吸支持的有效性。
方法：这是一项回顾性队列研究，于2020年3月至2022年1月进行。入学患者因自发性PM而患有COVID-19和急性呼吸衰竭，未进行侵入性通气。患者在重症监护病房（ICU）接受有创通气（有创通气组）或V-VECMO支持（V-VECMO组）作为主要治疗选择。主要结果是入住ICU后90天的死亡率和ICU出院。
结果：本研究纳入了22例患者（有创通气组：13[59%]；V-VECMO组：9[41%]）。V-VECMO策略与较低的死亡率显着相关（风险比[HR]0.33[95％CI0.12-0.97]，p=0.04)。在入住ICU后30天内，V-VECMO组中有5例（38％）患者接受了插管，有创通气组中有8例（89％）患者需要V-VECMO支持。V-VECMO组有3例（33%）患者在90天内从ICU出院，有创通气组有1例（8%）患者出院（HR4.71[95%CI0.48-45.3]，p=0.18）。
结论：初步数据表明，无侵入性通气的V-VECMO可改善因自发性PM引起的COVID-19相关急性呼吸衰竭的生存率。该研究的回顾性设计和有限的样本量强调了额外调查的必要性，并应谨慎行事。
方法：这是一项回顾性队列研究，于2020年3月至2022年1月进行。入学患者因自发性PM而患有COVID-19和急性呼吸衰竭，未进行侵入性通气。患者在重症监护病房（ICU）接受有创通气（有创通气组）或V-VECMO支持（V-VECMO组）作为主要治疗选择。主要结果是入住ICU后90天的死亡率和ICU出院。
结果：本研究纳入了22例患者（有创通气组：13[59%]；V-VECMO组：9[41%]）。V-VECMO策略与较低的死亡率显着相关（风险比[HR]0.33[95％CI0.12-0.97]，p=0.04)。在入住ICU后30天内，V-VECMO组中有5例（38％）患者接受了插管，有创通气组中有8例（89％）患者需要V-VECMO支持。V-VECMO组有3例（33%）患者在90天内从ICU出院，有创通气组有1例（8%）患者出院（HR4.71[95%CI0.48-45.3]，p=0.18）。
结论：初步数据表明，无侵入性通气的V-VECMO可改善因自发性PM引起的COVID-19相关急性呼吸衰竭的生存率。该研究的回顾性设计和有限的样本量强调了额外调查的必要性，并应谨慎行事。
