{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:12:02Z","timestamp":1792098722806,"version":"4.4.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The role of excessive inspiratory effort in promoting alveolar and pleural rupture resulting in air leak (AL) in patients with SARS-CoV-2 induced acute respiratory failure (ARF) while on spontaneous breathing is undetermined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among all patients with COVID-19 related ARF admitted to a respiratory intensive care unit (RICU) and receiving non-invasive respiratory support, those developing an AL were and matched 1:1 [by means of PaO2\/FiO2 ratio, age, body mass index-BMI and subsequent organ failure assessment (SOFA)] with a comparable population who did not (NAL group). Esophageal pressure (\u0394P<jats:sub>es<\/jats:sub>) and dynamic transpulmonary pressure (\u0394P<jats:sub>L<\/jats:sub>) swings were compared between groups. Risk factors affecting AL onset were evaluated. The composite outcome of ventilator-free-days (VFD) at day 28 (including ETI, mortality, tracheostomy) was compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Air leak and NAL groups (<jats:italic>n<\/jats:italic> = 28) showed similar \u0394P<jats:sub>es<\/jats:sub>, whereas AL had higher \u0394P<jats:sub>L<\/jats:sub> (20 [16\u201321] and 17 [11\u201320], <jats:italic>p<\/jats:italic> = 0.01, respectively). Higher \u0394P<jats:sub>L<\/jats:sub> (OR = 1.5 95%CI[1\u20131.8], <jats:italic>p<\/jats:italic> = 0.01), positive end-expiratory pressure (OR = 2.4 95%CI[1.2\u20135.9], <jats:italic>p<\/jats:italic> = 0.04) and pressure support (OR = 1.8 95%CI[1.1\u20133.5], <jats:italic>p<\/jats:italic> = 0.03), D-dimer on admission (OR = 2.1 95%CI[1.3\u20139.8], <jats:italic>p<\/jats:italic> = 0.03), and features suggestive of consolidation on computed tomography scan (OR = 3.8 95%CI[1.1\u201315], <jats:italic>p<\/jats:italic> = 0.04) were all significantly associated with AL. A lower VFD score resulted in a higher risk (HR = 3.7 95%CI [1.2\u201311.3], <jats:italic>p<\/jats:italic> = 0.01) in the AL group compared with NAL. RICU stay and 90-day mortality were also higher in the AL group compared with NAL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In spontaneously breathing patients with COVID-19 related ARF, higher levels of \u0394P<jats:sub>L<\/jats:sub>, blood D-dimer, NIV delivery pressures and a consolidative lung pattern were associated with AL onset.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.848639","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T06:47:20Z","timestamp":1648709240000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Risk Factors for Pulmonary Air Leak and Clinical Prognosis in Patients With COVID-19 Related Acute Respiratory Failure: A Retrospective Matched Control 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