Macklin effect in critically COVID-19 patients: Observational single-center analysis.

Area of Science:

• Critical Care Medicine
• Pulmonology
• Radiology

Background:

• The Macklin effect (ME), characterized by air in the lung interstitium, is a potential complication in mechanically ventilated patients.
• COVID-19 ARDS can lead to increased lung pressures and susceptibility to barotrauma.

Purpose of the Study:

• To determine the incidence and impact of the Macklin effect (ME) in critically ill COVID-19 patients.
• To investigate the correlation between ME and pneumothorax (PNX), spontaneous pneumomediastinum (SP), and barotraumatic complications (BC).

Main Methods:

• Observational, single-center study including 138 critically ill COVID-19 patients.
• Retrospective analysis of chest computed tomography (Ch-CT) scans to identify ME.
• Exclusion of patients with pre-existing PNX, SP, or tracheal lesions.

Main Results:

• ME was detected in 5.8% on initial Ch-CT and 10.9% during ICU stay.
• Pneumothorax (PNX) occurred in 17.4%, subcutaneous emphysema in 14.5%, and total BC in 23.9%.
• Early ME detection on initial Ch-CT was significantly associated with PNX (OR 5.5), SP (OR 12.77), and BC (OR 11.44), and predicted BC development (HR 5.91).

Conclusions:

• Early identification of the Macklin effect in COVID-19 patients is crucial.
• ME is a significant predictor of barotraumatic complications, including pneumothorax and spontaneous pneumomediastinum.
• Recognizing ME may improve clinical management and patient outcomes in severe COVID-19.