{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:56:27Z","timestamp":1757314587177,"version":"3.41.2"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acute respiratory failure is the predominant presentation of intensive care unit (ICU) patients with COVID\u201019, and lung protective strategies are recommended to mitigate additional respiratory complications such as air\u2010leak syndrome. The aim of this study is to investigate the prevalence, type, and timing of air\u2010leak syndrome with regards to associated factors and patient outcome in patients with COVID\u201019 in ICUs at a large Swedish emergency hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included all adult patients admitted to an ICU for COVID\u201019\u2010related respiratory failure at S\u00f6dersjukhuset between March 6, 2020, and June 6, 2021. Primary outcomes were proportion of patients diagnosed with air\u2010leak syndrome and its different types of manifestations, and timing of diagnoses in relation to ICU admission and initiation of invasive ventilation. Secondary outcomes included the highest level of respiratory support prior to the diagnosis of air\u2010leak syndrome, patient characteristics and treatment variables associated with air\u2010leak syndrome, and 90\u2010day mortality for patients with air\u2010leak syndrome compared to those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of a total of 669 patients, 81 (12%) were diagnosed with air\u2010leak syndrome. Air\u2010leak syndrome manifested as pneumomediastinum (PMD) (<jats:italic>n<\/jats:italic>\u2009=\u200958, 72%), pneumothorax (PTX) (<jats:italic>n<\/jats:italic>\u2009=\u200943, 53%), subcutaneous emphysema (SCE) (<jats:italic>n<\/jats:italic>\u2009=\u200928, 35%) and pneumatocele (PC) (<jats:italic>n<\/jats:italic>\u2009=\u20094, 4.9%). Air\u2010leak syndrome was diagnosed at a median of 14\u2009days (IQR 6\u201322) after ICU admission and 12\u2009days (IQR 6\u201319) following the initiation of invasive ventilation. The highest respiratory support prior to diagnosis was invasive ventilation (IV) in 64 patients (79%), non\u2010invasive ventilation in two patients (2.5%), and low\u2010 or high\u2010flow oxygen in 15 patients (19%). Multiple logistic regression showed that pulmonary disease at baseline (OR 1.87, 95% CI 1.07\u20133.25), a lower body mass index (OR 0.95, 95% CI 0.9\u20130.99), admission later compared with earlier in the pandemic (OR 3.89, 95% CI 2.14\u20137.08), and IV (OR 3.92, 95% CI 2.07\u20137.44) were associated with an increased risk of air\u2010leak syndrome. Compared with patients not diagnosed with air\u2010leak syndrome, patients with air\u2010leaks had a higher mortality at 90\u2009days after ICU admission, 46% versus 26% (<jats:italic>p<\/jats:italic> &lt;.001). However, the mortality rate differed with different air\u2010leak manifestations, 47% for PMD, 47% for PTX, 50% for the combination of both PMD and PTX and 0% in patients with only SCE and\/or PC, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In 669 ICU patients with COVID\u201019, 12% had one or more manifestations of air\u2010leak syndrome. Notably, PMD, rather than PTX, was the most common manifestation, suggesting a potentially distinctive feature of COVID\u201019\u2010related air\u2010leak syndrome. Further research is needed to determine whether COVID\u201019 involves different pathophysiological or iatrogenic mechanisms compared with other critical respiratory conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration of Clinical Trial<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>, identifying number, NCT05877443.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>This single\u2010centre cohort study of air leakage into soft tissue in ventilated COVID cases presents findings for associated factors and clinical manifestations, including with different COVID\u201019 periods and treatments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14582","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T13:01:20Z","timestamp":1739365280000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A descriptive, retrospective single\u2010centre study of air\u2010leak syndrome in intensive care unit patients with COVID\u201019"],"prefix":"10.1111","volume":"69","author":[{"given":"Alice L\u00f6wing","family":"Jensen","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Litorell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9735-4160","authenticated-orcid":false,"given":"Jonathan","family":"Grip","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, CLINTEC Karolinska Institutet  Stockholm Sweden"},{"name":"Function Perioperative Medicine and Intensive Care Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4878-6447","authenticated-orcid":false,"given":"Martin","family":"Dahlberg","sequence":"additional","affiliation":[{"name":"Department of Surgery S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9041-2468","authenticated-orcid":false,"given":"Eva","family":"Joelsson\u2010Alm","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5836-8594","authenticated-orcid":false,"given":"Sandra","family":"Jonmarker","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12839"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2009575"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005043421801"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032193"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214103"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005372"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2187-7"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00385-2020"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/08850666211019719"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.5501\/wjv.v11.i4.176"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e33679"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.103221"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010-w1"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021436"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02697-2020"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04228-1"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30156-0"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.02.005"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202303-0558WS"},{"issue":"4","key":"e_1_2_10_21_1","article-title":"Operationalizing the new global definition of ARDS: a retrospective cohort study from South Africa. CHEST","volume":"2","author":"Anesi GL","year":"2024","journal-title":"Crit Care"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2021.05.001"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10122738"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00229-0"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200601000-00003"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31828a2aa1"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05594-1"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1360-z"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13781"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268820003179"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0257891"},{"key":"e_1_2_10_32_1","unstructured":"Low\u2010cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID\u201019 [press release].https:\/\/www.recoverytrial.net\/news\/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2021.03.018"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-023-02093-1"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/106002807400801104"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1410639"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.14582","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T12:54:06Z","timestamp":1742734446000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.14582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,12]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/aas.14582"],"URL":"https:\/\/doi.org\/10.1111\/aas.14582","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"type":"print","value":"0001-5172"},{"type":"electronic","value":"1399-6576"}],"subject":[],"published":{"date-parts":[[2025,2,12]]},"assertion":[{"value":"2024-07-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14582"}}