GKD Anest Yoð Bak Dern Derg. 2022; 28(2): 164-171 | DOI: 10.14744/GKDAD.2021.03371

Üçüncü Basamak Yoðun Bakýmda COVID-19'lu Hastalarda Pnömotoraks

Þerife Gökbulut Bektaþ¹, Demet Bölükbaþý², Baha Burak Konak², Ahmet Gökhan Akdað¹, Aydan Çalýþkan¹, Seval Ýzdeþ^2
1Ankara Þehir Hastanesi, Yoðun Bakým Kliniði, Ankara, Türkiye
²Ankara Yýldýrým Beyazýt Üniversitesi, Yoðun Bakým Kliniði, Ankara, Türkiye

Amaç: Çalýþmanýn amacý, üçüncü basamak yoðun bakým ünitesinde koronavirüs hastalýðý 2019 (COVID-19) tanýsý ile yatýrýlan ve pnömotoraks geliþen hastalarýn laboratuvar bulgularýnýn klinik özellikleri ve tedavileri ile birlikte incelenmesi, pnömotoraks epidemiyolojisi ve risklerinin belirlenmesidir.
Yöntem: Çalýþma; 1 Nisan 2020 ile 1 Ocak 2021 tarihleri arasýnda üç adet üçüncü basamak yoðun bakým ünitesinde (her biri 24 yataklý) takip edilen 681 COVID-19 hastasýnýn elektronik kayýtlarý geriye dönük olarak incelenerek gerçekleþtirildi. Hastalarýn demografik ve klinik özellikleri, laboratuvar bulgularý, mekanik ventilatör parametreleri ve akciðer görüntülemeleri geriye dönük olarak deðerlendirildi.
Bulgular: COVID-19 geçiren 681 hastanýn 22'sinde (%3,2) pnömotoraks ve 481'inde (%70,6) akut respiratuar distres sendromu (ARDS) tespit edildi. Tüm çalýþma hastalarý ARDS taný kriterlerini karþýladý. Mortalite oranlarý tüm hastalarda %43.4 (296/681), ARDS'li hastalarda %52.8 (254/481), pnömotorakslý hastalarda ise %86,3 (19/22) idi. Hastalarda ortalama 17,4±4,8 gün içinde pnömotoraks geliþti. Semptomlarýn baþladýðý 1. haftada hastalarýn bilgisayarlý tomografilerinde yaygýn buzlu cam opa-siteleri, yama infiltratlarý ile heterojenik daðýlým, alveolar eksüdalar, interstisyel kalýnlaþma gözlendi.
Sonuç: ARDS'li COVID-19 hastalarýnda pnömotoraksýn mortaliteyi önemli ölçüde artýrdýðýný gözlemledik. Pnömotoraksýn özelliklerinin anlaþýlmasýnýn ve önlenmesinin mortalitenin azaltýlmasýna önemli katký saðlayacaðýna inanýyoruz.

Anahtar Kelimeler: ARDS, COVID-19, mortalite, pnömotoraks, yoðun bakým ünitesi

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Pneumothorax in Patients with COVID-19 in Tertiary Intensive Care

Þerife Gökbulut Bektaþ¹, Demet Bölükbaþý², Baha Burak Konak², Ahmet Gökhan Akdað¹, Aydan Çalýþkan¹, Seval Ýzdeþ^2
1Department of Intensive Care Unit, Ankara City Hospital, Ankara, Türkiye
²Department of Intensive Care Unit, Ankara Yýldýrým Beyazýt University, Ankara, Türkiye

Objectives: Objective of the study was to examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of coronavirus disease 2019 (COVID-19) and developed pneumothorax and to determine epidemiology and risks of pneumothorax.
Methods: The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary intensive care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were evaluated retrospectively.
Results: Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients was detected and acute respiratory distress syndrome (ARDS) in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4±4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their symptom onset.
Conclusion: We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.

Keywords: ARDS, COVID-19, intensive care unit, mortality, pneumothorax

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