1. A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients
- Author
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Diego Palumbo, Alberto Zangrillo, Alessandro Belletti, Giorgia Guazzarotti, Maria Rosa Calvi, Francesca Guzzo, Renato Pennella, Giacomo Monti, Chiara Gritti, Marilena Marmiere, Margherita Rocchi, Sergio Colombo, Davide Valsecchi, Anna Mara Scandroglio, Lorenzo Dagna, Patrizia Rovere-Querini, Moreno Tresoldi, Giovanni Landoni, Francesco De Cobelli, Carolina Faustini, Nicolò Maimeri, Rosalba Lembo, Giuseppe Di Lucca, Raffaella Scotti, Maria Vittoria Lavorato, Alessandro Tomellieri, Corrado Campochiaro, Fatemeh Darvizeh, Francesca Calabrese, Roberto Mapelli, Nicola Pasculli, Giovanni Borghi, Antonella Cipriani, Maria Grazia Calabrò, Martina Crivellari, Annalisa Franco, Marina Pieri, Evgeny V. Fominskiy, Stefano Franchini, Antonio Dell'Acqua, Alessandro Marinosci, Giordano Vitali, Nicola Compagnone, Palumbo, D., Zangrillo, A., Belletti, A., Guazzarotti, G., Calvi, M. R., Guzzo, F., Pennella, R., Monti, G., Gritti, C., Marmiere, M., Rocchi, M., Colombo, S., Valsecchi, D., Scandroglio, A. M., Dagna, L., Rovere-Querini, P., Tresoldi, M., Landoni, G., De Cobelli, F., Faustini, C., Maimeri, N., Lembo, R., Di Lucca, G., Scotti, R., Lavorato, M. V., Tomellieri, A., Campochiaro, C., Darvizeh, F., Calabrese, F., Mapelli, R., Pasculli, N., Borghi, G., Cipriani, A., Calabro, M. G., Crivellari, M., Franco, A., Pieri, M., Fominskiy, E. V., Franchini, S., Dell'Acqua, A., Marinosci, A., Vitali, G., and Compagnone, N.
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ARDS ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,LR, likelihood ratio ,Pneumomediastinum ,Acute respiratory distress ,Critical Care and Intensive Care Medicine ,Article ,Mechanical ventilation ,Humans ,Medicine ,ARDS, acute respiratory distress syndrome ,Mediastinal Emphysema ,COVID-19, coronavirus disease 2019 ,PMD, pneumomediastinum ,Respiratory Distress Syndrome ,Chest imaging ,Acute respiratory distress syndrome ,SARS-CoV-2 ,business.industry ,Tomography, X-ray computed ,Pneumothorax ,COVID-19 ,medicine.disease ,PPV, positive predictive value ,PNX, pneumothorax ,NPV, negative predictive value ,Case-Control Studies ,Radiological weapon ,Radiology ,business - Abstract
Purpose: To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). Materials and methods: This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. Results: 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positives) demonstrated Macklin effect (p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Conclusions: Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.
- Published
- 2021
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