COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis.

Pablo Redruello-Guerrero, Marta Ruiz-Del-Pino, Carmen Jiménez-Gutiérrez, Paula Jiménez-Gutiérrez, Ana Carrascos-Cáliz, Alejandro Romero-Linares, Antonio Jesús Láinez Ramos-Bossini, Mario Rivera-Izquierdo, Antonio Cárdenas-Cruz

Journal: Medicina intensiva 2023;47(10):583-593

PMID: 37302941

Free Full Text on Elsevier Science View on PubMed

Plain Language Summary

During the Covid-19 pandemic there was an increase in the number of individuals experiencing a collapsed lung, otherwise known as a pneumothorax (PNX) or pneumomediastinum (PNMD). The reasons for increased PNX are unclear and this systematic review and meta-analysis of 12 studies including 4901 individuals with Covid-19 aimed to determine what may be responsible for this. The results showed that 1629 individuals experienced a PNX and 253 a PNMD, and death was higher amongst those who developed PNX and PNMD. There were strong associations between the occurrence of PNX and PNMD and death. It was concluded that PNX and PNMD significantly increased the risk of dying in individuals with Covid-19 and it was proposed that the term Covid-19-Associated Lung Weakness (CALW) should be applied to those who experience PNX of PNMD. There was some concern that the quality of the research used was very low and so this study could be used by healthcare professionals to understand that PNX and PNMD in Covid-19 patients should be closely monitored and managed.

Abstract

OBJECTIVES

To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW).

DESIGN

Systematic review with meta-analysis.

SETTING

Intensive Care Unit (ICU).

PARTICIPANTS

Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay.

INTERVENTIONS

Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD.

MAIN VARIABLES OF INTEREST

Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis.

RESULTS

Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution.

CONCLUSIONS

Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).

Address: Departamento de Medicina, Universidad de Granada, Granada, Spain. Electronic address: [email protected].; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Radiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.; Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain.; Departamento de Medicina, Universidad de Granada, Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario de Poniente, Almería, Spain. Electronic address: [email protected].

DOI: 10.1016/j.medine.2023.06.001