影响诊断为 COVID-19 的重症监护随访患者发生气胸的风险因素。

IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES BMC Infectious Diseases Pub Date : 2024-11-05 DOI:10.1186/s12879-024-10147-z
Yasemin Bozkurt Turan
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引用次数: 0

摘要

背景:气胸是 COVID-19 鲜为人知的并发症。这些患者的总体预后较差,需要更多的呼吸支持,住院时间较长,死亡率较高。本研究旨在确定哪些因素可预测被诊断为 COVID-19、入住 COVID-19 重症监护病房(ICU)并发生气胸的管式胸腔造口术患者的死亡率:这项观察性研究在土耳其马尔马拉大学彭迪克培训与研究医院的所有 COVID-19 重症监护室进行。对被诊断为 COVID-19 肺炎并因气胸而插入胸腔管的重症监护病房入院患者进行了回顾性调查:结果:100 名患者接受了胸腔插管手术。他们的中位年龄为 68 岁(57-78 岁),63% 为男性。随访时间的中位数为 20 [10-29] 天,从最初的逆转录酶聚合酶链反应(RT-PCR)结果到胸廓切开术的中位数为 17 [9-23] 天。90% 的患者最初的 RT-PCR 结果为阳性,8% 为阴性,2% 结果不明。半数患者在胸部计算机断层扫描(CT)中显示肺部受累(n = 50),22 名患者的 COVID-19 报告和数据系统(CO-RADS)评分为 5(22%)。62 名患者接受了右侧管式胸腔造口术,24 名患者接受了左侧造口术,14 名患者接受了双侧造口术。患者的平均呼气末正压 (PEEP) 为 10.31 (4.48) cm H2O,平均吸气峰压 (PIP) 为 26.69 (5.95) cm H2O,平均吸入氧饱和度 (FiO2) 为 80.06 (21.11) %,平均呼吸频率为 23.71 (5.62) 次/分钟,平均高流量鼻插管 (HFNC) 流速为 70 (8.17) L/分钟。87 名患者进行了插管(87%),6 名患者使用了非再通气储气罐面罩,4 名患者使用了高流量鼻导管,2 名患者使用了无创机械通气 (NIV),1 名患者使用了简易面罩。70 名患者有合并症,25 名患者无合并症,5 名患者合并症状况不明。合并症包括高血压(38%)、糖尿病(23%)、心血管疾病(12%)、慢性阻塞性肺病(5%)、恶性肿瘤(3%)、风湿病(3%)、痴呆(2%)和其他疾病(9%)。100 名患者中有 12 人存活。中位存活时间为20天(17.82-22.18),28天总存活率中位数为29%(20-38%)。多变量考克斯比例危险模型显示,年龄超过 68 岁(HR = 2.23 [95% CI: 1.39-3.56];P = 0.001)、除插管外的氧合状态(HR = 2.24 [95% CI: 1.11-4.52]; p = 0.024)、HCO3- 低于 22(正常范围为 22 至 26)(HR = 1.95 [95% CI: 1.08-3.50]; p = 0.026)是与 ICU 患者死亡率相关的风险因素:结论:COVID-19 肺炎患者的年龄超过 68 岁、接受插管以外的氧合治疗以及 HCO3- 值低于 22,是与气胸死亡率相关的预后因素。
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Risk factors affecting the development of pneumothorax in patients followed up in intensive care with a diagnosis of COVID-19.

Background: Pneumothorax is a little known and reported complication of COVID-19. These patients have poorer general outcomes and greater respiratory support requirements, longer hospitalization times, and higher mortality rates. The purpose of this study was to determine which factors predict mortality in patients with tube thoracostomy diagnosed with COVID-19, admitted to the COVID-19 intensive care unit (ICU), and developing pneumothorax.

Methods: This respective, observational study was conducted in all COVID-19 ICUs at the Marmara University Pendik Training and Research Hospital, Türkiye. Patients admitted to the ICU with diagnoses of COVID-19 pneumonia and with chest tubes inserted due to pneumothorax were investigated retrospectively.

Results: One hundred patients with tube thoracostomy were included in the study. Their median age was 68 (57-78), and 63% were men. The median follow-up time was 20 [10-29] days, and the median time from initial reverse transcriptase polymerase chain reaction (RT-PCR) results to tube thoracostomy was 17 [9-23] days. Initial RT-PCR results were positive in 90% of the patients, while 8% were negative, and 2% were unknown. Half the patients exhibited pulmonary involvement at thoracic computed tomography (CT) (n = 50), while 22 patients had COVID-19 reporting and data system (CO-RADS) scores of 5 (22%). Sixty-two patients underwent right tube thoracostomy, 24 left side placement, and 14 bilateral placement. The patients' mean positive end expiratory pressure (PEEP) level was 10.31 (4.48) cm H2O, with a mean peak inspiratory pressure (PIP) level of 26.69 (5.95) cm H2O, a mean fraction of inspired oxygen (FiO2) level of 80.06 (21.11) %, a mean respiratory rate of 23.71 (5.62) breaths/min, and a mean high flow nasal cannula (HFNC) flow rate of 70 (8.17) L/min. Eighty-seven patients were intubated (87%), six used non-rebreathable reservoir masks, four HFNC, two non-invasive mechanical ventilation (NIV), and one a simple face mask. Comorbidity was present in 70 patients, 25 had no comorbidity, and the comorbidity status of five was unknown. Comorbidities included hypertension (38%), diabetes mellitus (23%), cardiovascular disease (12%), chronic obstructive pulmonary disease (5%), malignancy (3%), rheumatological diseases (3%), dementia (2%) and other diseases (9%). Twelve of the 100 patients survived. The median survival time was 20 (17.82-22.18) days, and the median 28-day overall survival rate was 29% (20-38%). The multivariate Cox proportional hazards model indicated that age over 68 (HR = 2.23 [95% CI: 1.39-3.56]; p = 0.001), oxygenation status other than by intubation (HR = 2.24 [95% CI: 1.11-4.52]; p = 0.024), and HCO3- below 22 compared with a normal range of 22 to 26 (HR = 1.95 [95% CI: 1.08-3.50]; p = 0.026) were risk factors associated with mortality in patients in the ICU.

Conclusions: Age over 68, receipt of oxygenation other than by intubation, and HCO3- values lower than 22 in patients with COVID-19 pneumonia emerged as prognostic factors associated with mortality in terms of pneumothorax.

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来源期刊
BMC Infectious Diseases
BMC Infectious Diseases 医学-传染病学
CiteScore
6.50
自引率
0.00%
发文量
860
审稿时长
3.3 months
期刊介绍: BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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