Computed tomography findings of pulmonary interstitial emphysema in COVID-19: Looking through the lens.

Abstract

Listen

Translate article

Sir, We read Scialpi et al.’s[1] study evaluating the incidence of pulmonary interstitial emphysema (PIE) and other complications detected using computed tomography (CT) in COVID-19 patients. Although the findings are clinically relevant, some key aspects need to be clarified to define a specific impact and better understand. The authors emphasise early detection of the complications using CT that might help us optimise the ventilation option (noninvasive/invasive ventilation) to reduce the severity of complications. Although the basis is essential, there is controversy about the role of applied ventilation options, especially noninvasive ventilation (NIV) as an inducing factor of PIE or as a promoting factor.[2] In this sense, we also do not know how they can be identified and how to establish a better prevention strategy? The authors have summarised the number of PIE patients who received NIV and invasive mechanical ventilation (IMV). The relationship between PIE and NIV will be interesting. We could not establish an adequate interpretation and relationship of NIV with the PIE or other complications as comparative data required are lacking in the authors’ presented data. COVID-19 patients tend to have a higher incidence of barotrauma with IMV.[23] In this context, a comparison of PIE incidence in patients treated with NIV and IMV will help decide the mode of ventilation. Further, the airway pressures and ventilatory pressure setup in PIE and non-PIE patients receiving NIV will also help us optimise settings.[4] Further, we could not find precise mechanisms and possibilities that determine the evolution of different forms of PIE. In the authors’ cohort, variations in PIE were revealed in 25 patients and associated with pneumomediastinum, subcutaneous emphysema, and pneumothorax in 25 (100%), 16 (64%), and 7 (28%), respectively.[1] However, the determining factors that explain this variation allowing the framework of lung-protective strategies, prevention, and early diagnosis in high-risk patients are missing. It will be helpful for the readers if the authors present any such data from the cohort. It will help us plan future studies to evaluate the best tool for prevention and treatment. Author contribution HMRK, AME–observation, literature search, manuscript preparation, and editing. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.