Observational studyJournal of critical care2021
A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients.
Observational study in Journal of critical care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Artificial Intelligence-based Identification of Imaging Biomarkers of Lung FRAILty in Patients With Acute Respiratory Distress Syndrome.
Pulmonary Interstitial Emphysema (Macklin Effect), Quantitative Imaging Analysis and CytoKine Profiling to Predict Lung Frailty IN ARDS
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Effects of pulmonary air leak on patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis.BMC pulmonary medicine · 2023Pooled it
- When Asthma Leads to Air: Pneumomediastinum in a Child.Children (Basel, Switzerland) · 2026Article
- Clinical characteristics of 40 patients with spontaneous pneumomediastinum: a retrospective study and literature review.Journal of cardiothoracic surgery · 2026Review
- Spontaneous Pneumomediastinum in COVID-19 and Myasthenic-like Symptom Complications in Two Relatives: A Coincidence or Spike Toxicity with Thymic Response in Predisposed Individuals? Two Clinical Cases with a Comprehensive Literature Review.Journal of clinical medicine · 2025Article
- Extracorporeal membrane oxygenation for prevention of barotrauma in patients with respiratory failure: A scoping review.Artificial organs · 2025Article
- Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome.Journal of clinical medicine · 2024Article
- Laryngotracheal trauma-induced Macklin effect: A case report.SAGE open medical case reports · 2024Article
- Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database.BMC anesthesiology · 2023Observational
- P-SILI in critically ill COVID-19 patients: Macklin effect and the choice of noninvasive ventilatory support type.Critical care (London, England) · 2023Article
- Air leak, barotrauma susceptibility, and imaging in acute respiratory distress syndrome: novel application of an old tool.Intensive care medicine · 2022Article
- Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma.Journal of cardiothoracic and vascular anesthesia · 2022Article
- Air leaks in COVID-19.World journal of virology · 2022Review
- Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman.Cureus · 2022Article
- Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients.Respiratory medicine · 2022Observational
- An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review.Diagnostics (Basel, Switzerland) · 2022Review
- Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection.International journal of general medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo 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
methodsThis 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.
results37/173 (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).
conclusionsMacklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.