Analysis of the factors that affect survival among patients who developed subcutaneous emphysema monitored on COVID-19 diagnosis: single-centred research

Year 2022, Volume: 5 Issue: 5, 1394 - 1398, 25.09.2022

Tamer Direk , Kubilay İnan , Merve Şengül İnan , Mehmet Furkan Şahin , İlknur Aytekin Çelik , Nurettin Karaoglanoglu

https://doi.org/10.32322/jhsm.1146541

Abstract

Aim: The COVID-19 patients with pulmonary involvement frequently develop pneumothorax, pneumomediastinum and subcutaneous emphysema due to barotrauma. Reviewing the literature, pneumothorax, pneumomediastinum and subcutaneous emphysema it can be observed among ICU patients due to the pulmonary involvement of the COVID-19 disease, and therefore, can cause mortality and morbidity. This study aims to analyse the factors that affect mortality in COVID-19 patients in ICUs who develop subcutaneous emphysema.
Material and Method: A total of 854 COVID-19 patients who were consulted from all branches in the Chest Surgery Clinic of Ankara City Hospital between September 1, 2020 - March 1, 2021 were retrospectively analyzed. Demographic characteristics, comorbid diseases and COVID-related tests (LDH, D-dimer, procalcitonin, ferritin, CRP, IL-6, lymphocyte percentage and neutrophil and lymphocyte ratio) imaging results and survival of 66 patients with subcutaneous emphysema were analyzed.
Results: Of the patients, 41 (62%) were male and 25 (38%) were female. The mean age was 63 years. 55 (83%) of these patients were followed up with invasive ventilation support due to general health impairment, increased oxygen demand and heart problems. Age, intubation and NLR were found to be statistically significant in terms of survival and death, on survival. It was discovered that age and intubation variables could be risk factors. The mortality rates were 1.01 times higher for the elderly compared to the younger patients and 13.8 times higher for the intubated compared to the non-intubated patients.
Conclusion: Age of patient and intubation can be regarded as risk factors for mortality in COVID-19 patients with subcutaneous emphysema, monitored in ICUs. Furthermore, comorbid diseases increase mortality rates.

Keywords

COVID-19, mortality, subcutaneous emphysema

Project Number

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References

• World Health Organization (WHO) Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance. Available from: https: //www.who.int/emergencies/diseases/novelcorona virus-2019 Accessed date: March 14 2020.
• Çiftçi B. The effect of coronavirus disease-2019 (COVID-19) according to gender on health-related quality of life. J Health Sci Med 2022; 5: 1030-5.
• Wu Z, McGoogan JM. characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323: 1239- 42.
• Halaclı B, Kaya A, Topeli A. Critically ill COVID-19 patient. Turk J Med Sci 2020; 50: 585-91.
• Güngörer B. Baseline demographic, clinical and laboratory risk factors for predicting admission to intensive care unit in patients diagnosed with COVID-19 in the emergency department. Anatolian Curr Med J 2021; 3; 279-83.
• Demirköse M, Ünver Ulusoy T, Solak Grassie S, et al. The role of chest tomography in the diagnosis of COVID-19. J Med Palliat Care 2022; 3: 1-6.
• Kesmez Can F, Alay H, Yılmaz S, et al. The thorax tomography correlation in COVID-19 RT-PCR positive patients. Anatolian Curr Med J 2021; 3; 145-50.
• Karaali R, Ersöz H, Akyol PY, Yurtsever G, Topal FE. Comparison of the tube thoracostomy techniques on treatment in COVID-19 patients with pneumothorax. J Health Sci Med 2022; 5: 306-12.
• Ertürk T, İnangil D, Pakdil EL, et al. Medical device related pressure injuries in COVID-19 patients followed up in an intensive care unit. J Health Sci Med 2022; 5: 227-33.
• Guven BB, Erturk T, Kompe Ö. Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax. Epidemiol Infect 2021; 149: 137.
• Koç İ, Dökme A, Bayraktar A, Kaya A. Noninvazif mekanik ventilasyon sonrası gelişen iyatrojenik pnömotoraks olgusu. J Clin Exp Invest 2014; 5.
• Talan L, Şaşal Solmaz FG, Ercan U. COVID-19 pneumonia and pneumothorax: case series. Tuberk Toraks 2020; 68: 437-43.
• Jones E, Gould A, Pillay TD. Subcutaneous emphysema, pneumomediastinum, and pneumothorax in critically ill patients with coronavirus disease 2019: a retrospective cohort study. Crit Care Explor 2020; 2: 210
• Lemmers DHL, Abu Hilal M, Bnà C. Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty? ERJ Open Res 2020; 6: 385-2020
• Manna S, Maron SZ, Cedillo MA. Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19. Clin Imaging 2020; 67: 207-213
• Cut TG, Tudoran C, Lazureanu VE, Marinescu AR, Dumache R, Tudoran M. Spontaneous pneumomediastinum, pneumothorax, pneumopericardium and subcutaneous emphysema-not so uncommon complications in patients with COVID-19 pulmonary infection-a series of cases. J Clin Med 2021; 10: 1346.
• Al-Azzawi M, Douedi S, Alshami A. Spontaneous subcutaneous emphysema and pneumomediastinum in COVID-19 patients: an indicator of poor prognosis? Am J Case Rep 2020; 21: 925557
• IE Ozsoy, MA Tezcan. Is spontaneous pneumomediastinum a poor prognostic factor in COVID-19? J Coll Physicians Surg Pak 2021; 31: 132-7.
• Nasa P, Juneja D, Jain R. Air leak with COVID-19 - A meta- summary. Asian Cardiovasc Thorac Ann 2022; 30: 237-44.
• Jimeno S, Ventura PS, Castellano JM, et al. Prognostic implications of neutrophil- lymphocyte ratio in COVID-19. Eur J Clin Invest 2021; 51: 13404.