Elsevier

Clinical Imaging

Volume 97, May 2023, Pages 50-54
Clinical Imaging

Cardiothoracic Imaging
The Macklin effect closely correlates with pneumomediastinum in acutely ill intubated patients with COVID-19 infection

https://doi.org/10.1016/j.clinimag.2023.03.003Get rights and content

Highlights

  • We assessed the association of the Macklin Effect and pulmonary barotrauma in intubated COVID-19 patients

  • Pneumomediastinum occurred significantly more frequently in patients with the Macklin effect than those without

  • There was a trend toward more pneumothoraces in patients with the Macklin Effect; pneumothorax was frequently omolateral

Abstract

Purpose

Patients with COVID-19 infection are frequently found to have pulmonary barotrauma. Recent work has identified the Macklin effect as a radiographic sign that often occurs in patients with COVID-19 and may correlate with barotrauma.

Methods

We evaluated chest CT scans in COVID-19 positive mechanically ventilated patients for the Macklin effect and any type of pulmonary barotrauma. Patient charts were reviewed to identify demographic and clinical characteristics.

Results

The Macklin effect on chest CT scan was identified in a total of 10/75 (13.3%) COVID-19 positive mechanically ventilated patients; 9 developed barotrauma. Patients with the Macklin effect on chest CT scan had a 90% rate of pneumomediastinum (p < 0.001) and a trend toward a higher rate of pneumothorax (60%, p = 0.09). Pneumothorax was most frequently omolateral to the site of the Macklin effect (83.3%).

Conclusion

The Macklin effect may be a strong radiographic biomarker for pulmonary barotrauma, most strongly correlating with pneumomediastinum. Studies in ARDS patients without COVID-19 are needed to validate this sign in a broader population. If validated in a broad population, future critical care treatment algorithms may include the Macklin sign for clinical decision making and prognostication.

Keywords

Macklin effect
Barotrauma
Pneumothorax
Mediastinum

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