Original Research
Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients

https://doi.org/10.1016/j.rmed.2022.106853Get rights and content

Highlights

  • Macklin effect on baseline CT accurately predicts barotrauma in COVID-19 patients.

  • Mean time from Macklin effect detection and barotrauma development was 3.2 days.

  • Macklin effect is a reliable radiological marker of lung frailty.

  • Macklin effect on baseline CT accurately predicts lung damage progression.

  • Barotrauma-risk stratification allows use of personalized management strategies.

Abstract

Purpose

To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients.

Materials and methods

This is an observational, case-control study. Consecutive COVID-19 patients who underwent chest CT scan at hospital admission during the study time period (October 1st, 2020–April 31st, 2021) were identified. Macklin effect accuracy for prediction of spontaneous barotrauma was measured in terms of sensitivity, specificity, positive (PPV) and negative predictive values (NPV).

Results

Overall, 981 COVID-19 patients underwent chest CT scan at hospital arrival during the study time period; 698 patients had radiological signs of interstitial pneumonia and were considered for further evaluation. Among these, Macklin effect was found in 33 (4.7%), including all 32 patients who suffered from barotrauma lately during hospital stay (true positive rate: 96.9%); only 1/33 with Macklin effect did not develop barotrauma (false positive rate: 3.1%). No barotrauma event was recorded in patients without Macklin effect on baseline chest CT scan. Macklin effect yielded a sensitivity of 100% (95% CI: 89.1–100), a specificity of 99.85% (95% CI: 99.2–100), a PPV of 96.7% (95% CI: 80.8–99.5), a NPV of 100% and an accuracy of 99.8% (95% CI: 99.2–100) in predicting PMD/PNX, with a mean advance of 3.2 ± 2.5 days. Moreover, all Macklin-positive patients developed ARDS requiring ICU admission and, in 90.1% of cases, invasive mechanical ventilation.

Conclusions

Macklin effect has high accuracy in predicting PMD/PNX in COVID-19 patients; it is also an excellent predictor of disease severity.

Keywords

Acute respiratory distress syndrome
Mechanical ventilation
Computed tomography
Pneumothorax
Pneumomediastinum
Barotrauma
Intensive care

Abbreviations

ARDS
acute respiratory distress syndrome
COVID-19
coronavirus disease 2019
NPV
negative predictive value
PMD
pneumomediastinum
PNX
pneumothorax
PPV
positive predictive value

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