AUTHOR=Tonelli Roberto , Bruzzi Giulia , Manicardi Linda , Tabbì Luca , Fantini Riccardo , Castaniere Ivana , Andrisani Dario , Gozzi Filippo , Pellegrino Maria Rosaria , Trentacosti Fabiana , Dall’Ara Lorenzo , Busani Stefano , Franceschini Erica , Baroncini Serena , Manco Gianrocco , Meschiari Marianna , Mussini Cristina , Girardis Massimo , Beghè Bianca , Marchioni Alessandro , Clini Enrico 

TITLE=Risk Factors for Pulmonary Air Leak and Clinical Prognosis in Patients With COVID-19 Related Acute Respiratory Failure: A Retrospective Matched Control Study

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.848639

DOI=10.3389/fmed.2022.848639

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>The role of excessive inspiratory effort in promoting alveolar and pleural rupture resulting in air leak (AL) in patients with SARS-CoV-2 induced acute respiratory failure (ARF) while on spontaneous breathing is undetermined.</p></sec><sec><title>Methods</title><p>Among all patients with COVID-19 related ARF admitted to a respiratory intensive care unit (RICU) and receiving non-invasive respiratory support, those developing an AL were and matched 1:1 [by means of PaO2/FiO2 ratio, age, body mass index-BMI and subsequent organ failure assessment (SOFA)] with a comparable population who did not (NAL group). Esophageal pressure (ΔP<sub>es</sub>) and dynamic transpulmonary pressure (ΔP<sub>L</sub>) swings were compared between groups. Risk factors affecting AL onset were evaluated. The composite outcome of ventilator-free-days (VFD) at day 28 (including ETI, mortality, tracheostomy) was compared between groups.</p></sec><sec><title>Results</title><p>Air leak and NAL groups (<italic>n</italic> = 28) showed similar ΔP<sub>es</sub>, whereas AL had higher ΔP<sub>L</sub> (20 [16–21] and 17 [11–20], <italic>p</italic> = 0.01, respectively). Higher ΔP<sub>L</sub> (OR = 1.5 95%CI[1–1.8], <italic>p</italic> = 0.01), positive end-expiratory pressure (OR = 2.4 95%CI[1.2–5.9], <italic>p</italic> = 0.04) and pressure support (OR = 1.8 95%CI[1.1–3.5], <italic>p</italic> = 0.03), D-dimer on admission (OR = 2.1 95%CI[1.3–9.8], <italic>p</italic> = 0.03), and features suggestive of consolidation on computed tomography scan (OR = 3.8 95%CI[1.1–15], <italic>p</italic> = 0.04) were all significantly associated with AL. A lower VFD score resulted in a higher risk (HR = 3.7 95%CI [1.2–11.3], <italic>p</italic> = 0.01) in the AL group compared with NAL. RICU stay and 90-day mortality were also higher in the AL group compared with NAL.</p></sec><sec><title>Conclusion</title><p>In spontaneously breathing patients with COVID-19 related ARF, higher levels of ΔP<sub>L</sub>, blood D-dimer, NIV delivery pressures and a consolidative lung pattern were associated with AL onset.</p></sec>