A decrease in lung compliance, age and underlying lung disease (such as interstitial lung disease, chronic obstructive pulmonary disease cystic fibrosis, and certain lung infections like Pneumocystis jirovecii pneumonia) are known risk factors for non-trauma related pneumomediastinum, Yet the causes of the apparent increase in pneumomediastinum and subcutaneous emphysema in our COVID-19 patients were not clear. Nonetheless, during the COVID-19 pandemic there seemed to be a remarkable increase in pneumomediastinum/subcutaneous emphysema occurrence despite the use of the same unchanged protective mechanical ventilation protocol. In fact, this type of damage had been rarely seen in our ICU patients with ARDS. In the last two decades, as a consequence of this strategy, the occurrence of the main macroscopic signs of barotrauma such as pneumothorax, pneumomediastinum and subcutaneous emphysema have become very rare. kg −1 of ideal body weight while maintaining the airway plateau pressure below 30 cmH 2O.The current approach to protective ventilation, which became universally accepted after the ARDS Network trial, is based on the reduction of tidal volume to about 6 mL Since the beginning of the novel coronavirus disease 2019 (COVID-19) outbreak in Lombardy, Italy, the Fondazione Poliambulanza Hospital has treated over 2200 affected patients, and over 160 of them were admitted to the intensive care unit (ICU) for treatment of acute respiratory distress syndrome (ARDS) secondary to COVID-19.Īll patients admitted to ICU underwent invasive mechanical ventilation with protective criteria aimed at preventing ventilator-induced lung injury.
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