Negative pressure therapy as a safe alternative in the treatment of massive subcutaneous emphysema in critically ill patients COVID-19.
Álvaro Soler-Silva, Luis Sánchez-Guillén, Francisco López Rodriguez-Arias and 1 others
PMID 35063307WHAT IT FOUND
In a ventilated intensive care patient with massive subcutaneous emphysema, negative pressure therapy was followed by resolution in 5 days.
Minor wound bleeding occurred. This is a single case, not proof the treatment works.
Key findings
01An 82-year-old male patient with SARS-CoV-2 infection, ARDS and invasive ventilation developed massive subcutaneous emphysema after moderate subcutaneous emphysema appeared 24 h after intubation and progressed in the following 24 h.
02The paper reports that negative pressure therapy at continuous -150 mmHg was applied for 5 days and that the massive subcutaneous emphysema resolved in 5 days; the patient also had a chest tube, 4 days of conservative treatment and therapeutic anticoagulation.
03A minor surgical wound bleeding complication occurred while the patient was receiving therapeutic anticoagulation and was resolved with bedside silver nitrate cauterization.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report, so it cannot show that negative pressure therapy caused the resolution or that it works in other patients. No comparison group, control group or standard treatment was used. The patient also had a chest tube, invasive ventilation, therapeutic anticoagulation and conservative treatment, so the contribution of negative pressure therapy alone cannot be separated. The cause of the massive subcutaneous emphysema was not established; the paper discusses barotrauma, infection-related lung injury and chest tube effects. The authors describe the technique as effective and safe, but that is an interpretation from one case.
Declared interests
No funding was declared, and the authors declared no competing interests.
The easy way to misread this
Do not conclude that negative pressure therapy is proven to resolve massive subcutaneous emphysema in critically ill patients. This was one case, and the patient also had a chest tube, invasive ventilation, therapeutic anticoagulation and conservative treatment, so the contribution of negative pressure therapy alone cannot be separated.