{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:17:30Z","timestamp":1777853850508,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The occurrence of pneumomediastinum (PM) and\/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and\/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1306 patients were included. 4.3% (56\/1306) developed PM\/PTX, 3.8% (50\/1306) PM, 1.6% (21\/1306) PTX, and 1.1% (15\/1306) PM\u2009+\u2009PTX. 16.1% (9\/56) of patients with PM\/PTX had HFNC alone, while 83.9% (47\/56) had HFNC\u2009+\u2009CPAP\/BiPAP. In comparison, 41.7% (521\/1250) of patients without PM\/PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p\u2009&lt;\u2009.001), while 58.3% (729\/1250) had HFNC\u2009+\u2009CPAP\/BiPAP (OR 3.73; 95% CI 1.81-7.68; p\u2009&lt;\u2009.001). The probability of needing IMV among patients with PM\/PTX was 67.9% (36\/53) (OR 7.46; 95% CI 4.12-13.50; p\u2009&lt;\u2009.001), while it was 22.1% (262\/1185) among patients without PM\/PTX. Mortality among patients with PM\/PTX was 33.9% (19\/56) (OR 4.39; 95% CI 2.45-7.85; p\u2009&lt;\u2009.001), while it was 10.5% (131\/1250) among patients without PM\/PTX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM\/PTX, PM, PTX, and PM\u2009+\u2009PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM\/PTX had HFNC\u2009+\u2009CPAP\/BiPAP as the NIRS device, much more frequently than patients without PM\/PTX. The probabilities of IMV and death among patients with PM\/PTX were 67.9% and 33.9%, respectively, higher than those observed in patients without PM\/PTX, which were 22.1% and 10.5%, respectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666231180165","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T06:26:25Z","timestamp":1686551185000},"page":"1023-1041","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Severe SARS-CoV-2 Pneumonia and Pneumomediastinum\/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3384-3931","authenticated-orcid":false,"given":"Miguel","family":"Lorente-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Rafael","family":"Ter\u00e1n-Tinedo","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Zevallos-Villegas","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Laorden","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal 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