PMC9525618_01
Time series of radiographic results of a 67-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 1). (A) Chest X-ray 2 days before admission to the intensive care unit (ICU) showing pneumomediastinum (white arrows). (B) Computed tomography (CT) on the day of ICU admission after intubation showing diffuse bilateral ground-glass opacities with mixed consolidation and pneumomediastinum. (C) CT on the day of ICU admission after intubation showing pneumomediastinum with air tracking along the sheath of pulmonary vasculature, indicating the Macklin effect (white arrow). (D) CT on ICU day 4 showing improvement in pneumomediastinum by controlling spontaneous breathing.
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(A) Clinical course and ventilation settings of a 67-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 1). (B) Clinical course and ventilation settings of a 65-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 2). AC/PC, assist control/pressure control ventilation; CPAP/PS, continuous positive airway pressure/pressure support; CT, computed tomography; HFNC, high-flow nasal cannula; ICU, intensive care unit; NMBA, neuromuscular blocking agents; PIP, peak inspiratory pressure; PM, pneumomediastinum; Ptp E, transpulmonary pressure on expiration; Ptp I, transpulmonary pressure on inhalation; SIMV/PS, synchronized intermittent mandatory ventilation/pressure support.
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During the treatment, his PEEP and PIP were not strictly limited and applied as necessary for oxygenation and ventilation; his PIP was 28 cmH2O on the day of admission to our ICU, compared to 12 cmH2O in the previous hospital (Fig. 2B).
PMC9525618_02
Time series of radiographic results of a 67-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 1). (A) Chest X-ray 2 days before admission to the intensive care unit (ICU) showing pneumomediastinum (white arrows). (B) Computed tomography (CT) on the day of ICU admission after intubation showing diffuse bilateral ground-glass opacities with mixed consolidation and pneumomediastinum. (C) CT on the day of ICU admission after intubation showing pneumomediastinum with air tracking along the sheath of pulmonary vasculature, indicating the Macklin effect (white arrow). (D) CT on ICU day 4 showing improvement in pneumomediastinum by controlling spontaneous breathing.
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(A) Clinical course and ventilation settings of a 67-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 1). (B) Clinical course and ventilation settings of a 65-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 2). AC/PC, assist control/pressure control ventilation; CPAP/PS, continuous positive airway pressure/pressure support; CT, computed tomography; HFNC, high-flow nasal cannula; ICU, intensive care unit; NMBA, neuromuscular blocking agents; PIP, peak inspiratory pressure; PM, pneumomediastinum; Ptp E, transpulmonary pressure on expiration; Ptp I, transpulmonary pressure on inhalation; SIMV/PS, synchronized intermittent mandatory ventilation/pressure support.
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During the treatment, his PEEP and PIP were not strictly limited and applied as necessary for oxygenation and ventilation; his PIP was 28 cmH2O on the day of admission to our ICU, compared to 12 cmH2O in the previous hospital (Fig. 2B).
Time series of radiographic results of a 65-year-old man with acute respiratory distress syndrome caused by COVID-19 with pneumomediastinum (case 2). (A) Computed tomography (CT) on the day of intensive care unit (ICU) admission showing pneumomediastinum, subcutaneous emphysema from neck to abdomen, and bilateral ground-glass infiltrates. (B) CT on the day of ICU admission showing pneumomediastinum with air tracking along the sheath of pulmonary vasculature, implicating the Macklin effect (white arrow). (C) CT scan at ICU day11 showing complete resolution of pneumomediastinum by controlling spontaneous breathing.
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Computed tomography scan revealed extensive pneumomediastinum, subcutaneous emphysema from the neck to the abdomen, and bilateral ground-glass infiltrates (Fig. 3A). The patient underwent CT scan on day 11 of ICU admission; the scan showed complete resolution of pneumomediastinum (Fig. 3B).