Observational studyCritical care (London, England)2022
Spontaneous pneumomediastinum: a surrogate of P-SILI in critically ill COVID-19 patients.
Observational study in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 31 citations in OpenAlex.
- Article
- Impact of Environmental and Seasonal Factors on Spontaneous Pneumomediastinum With and Without Pneumorrhachis.The Kaohsiung journal of medical sciences · 2026Article
- 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
- A descriptive, retrospective single-centre study of air-leak syndrome in intensive care unit patients with COVID-19.Acta anaesthesiologica Scandinavica · 2025Observational
- Comparison of the risk of pneumothorax in COVID-19 and seasonal influenza.Scientific reports · 2024Article
- Pneumomediastinum and pneumoretroperitoneum after COVID-19: concealed intestinal perforation.BMC infectious diseases · 2024Article
- Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study.Heliyon · 2024Article
- Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study.European journal of medical research · 2024Article
- Time-dependent effect of prone position in ARDS: considerations for future research.Critical care (London, England) · 2024Article
- Inhaled volatile anesthetics in the intensive care unit.World journal of critical care medicine · 2024Review
- Valsalva Manoeuvre-Induced Pneumothorax and Pneumomediastinum in a Covid-19 Patient with ARDS: An Unusual Mechanism for this Complication.European journal of case reports in internal medicine · 2024Article
- Respiratory mechanics characteristics at the time of barotrauma presentation in patients with critical COVID-19 infection.Critical care science · 2024Article
- Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study.Journal of clinical medicine · 2023Article
- Patient Self-Inflicted Lung Injury-A Narrative Review of Pathophysiology, Early Recognition, and Management Options.Journal of personalized medicine · 2023Review
- Lessons from COVID-19 in the management of acute respiratory failure.Breathe (Sheffield, England) · 2023Review
- P-SILI in critically ill COVID-19 patients: Macklin effect and the choice of noninvasive ventilatory support type.Critical care (London, England) · 2023Article
- Optimizing the safety and efficacy of the awake venovenous extracorporeal membrane oxygenation in patients with COVID-19-related ARDS.Therapeutic advances in respiratory diseaseArticle
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Spontaneous pneumomediastinum (SP) has been described early during the COVID-19 pandemic in large series of patients with severe pneumonia, but most patients were receiving invasive mechanical ventilation (IMV) at the time of SP diagnosis. In this retrospective multicenter observational study, we aimed at describing the prevalence and outcomes of SP during severe COVID-19 with pneumonia before any IMV, to rule out mechanisms induced by IMV in the development of pneumomediastinum.Among 549 patients, 21 patients (4%) developed a SP while receiving non-invasive respiratory support, after a median of 6 days [4-12] from ICU admission. The proportion of patients requiring IMV was similar. However, the time to tracheal intubation was longer in patients with SP (6 days [5-13] vs. 2 days [1-4]; P = 0.00002), with a higher first-line use of non-invasive ventilation (n = 11; 52% vs. n = 150; 28%; P = 0.02). The 21 patients who developed a SP had persisting signs of severe lung disease and respiratory failure with lower ROX index between ICU admission and occurrence of SP (3.94 [3.15-5.55] at admission vs. 3.25 [2.73-4.02] the day preceding SP; P = 0.1), which may underline potential indirect signals of Patient-self inflicted lung injury (P-SILI).In this series of critically ill COVID-19 patients, the prevalence of SP without IMV was not uncommon, affecting 4% of patients. They received more often vasopressors and had a longer ICU length of stay, as compared with their counterparts. One pathophysiological mechanism may potentially be carried out by P-SILI related to a prolonged respiratory failure, as underlined by a delayed use of IMV and the evolution of the ROX index between ICU admission and the day preceding SP.
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