使用呼吸器的COVID-19病人發生氣胸與縱膈氣腫：案例系列與文獻綜述

Pneumothorax and Pneumomediastinum in COVID-19 Patients on Mechanical Ventilation: A Case Series and Literature Review

嚴重特殊傳染性肺炎（coronavirus disease 2019, COVID-19）現今已成為影響全球的主要流行病。COVID-19病人具有高住院與住加護病房比率，這些病人可能會使用侵襲性呼吸器或非侵襲性呼吸器支持。COVID-19住院病人中約0.3–4.2%會出現氣壓傷，如再接受侵入性機械通氣其氣壓傷的發生的比率約為14.7%且死亡率將近六成。在胸部電腦斷層掃描中發現的Macklin效應可以預測高氣壓傷風險的病人。目前在COVID-19使用呼吸器病人上主要設定仍為肺保護性通氣策略，儘管如此氣壓傷比率仍高，因此這些病人發生氣壓傷的原因可能是多因素的，可能與肺部病理因素有關，較高的PEEP可能進一步增強細胞激素反應，而加劇肺泡損傷，在PEEP為10 cmH2O左右或Pplat在小於30 cmH2O即能發生氣壓傷。因此，呼吸器的COVID-19病人在肺保護策略下PEEP的使用需要更加留意。

The Coronavirus Disease 2019 (COVID-19) has evolved into a major global pandemic, leading to high rates of hospitalization and admission to intensive care units for affected individuals. Patients with COVID-19 may undergo either invasive or non-invasive ventilator support. Approximately 0.3% to 4.2% of hospitalized COVID-19 patients develop barotrauma. If subjected to invasive mechanical ventilation, the incidence of barotrauma rises to around 14.7%, with an associated mortality rate of nearly 60%.
The Macklin effect, observed in chest computed tomography scans, can be used to predict patients at a high risk of developing barotrauma. Despite the widespread implementation of lung-protective ventilation strategies, the incidence of barotrauma remains high in COVID-19 patients. The causes of barotrauma in these patients are likely multifactorial and may be related to pulmonary pathological factors. Higher positive end-expiratory pressure (PEEP) may exacerbate cytokine responses, leading to increased alveolar damage. Barotrauma can occur at a PEEP of 10 cmH2O or a plateau pressure (Pplat) less than 30 cmH2O. Therefore, the use of PEEP in COVID-19 patients on ventilators, under the lung-protective ventilation strategy, requires careful consideration.