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The role of Macklin effect in management of ARDS: beyond spontaneous pneumomediastinum

  • Alessandro Belletti1,*,
  • Diego Palumbo2,3
  • Michele De Bonis3,4
  • Giovanni Landoni1,3
  • Alberto Zangrillo1,3

1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

2Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

3School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy

4Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

DOI: 10.22514/sv.2024.137 Vol.20,Issue 11,November 2024 pp.10-14

Submitted: 30 June 2024 Accepted: 14 August 2024

Published: 08 November 2024

*Corresponding Author(s): Alessandro Belletti E-mail: belletti.alessandro@hsr.it

Abstract

Barotrauma (including pneumomediastinum, pneumothorax or subcutaneous emphysema) is a frequent complication of patients with acute respiratory distress syndrome (ARDS) and is associated with worse outcome. Furthermore, some Authors hypothesize that pneumomediastinum could be a sign of ongoing patient self-inflicted lung injury (P-SILI) in patients with respiratory failure receiving non-invasive respiratory support. It has been recently found that a well-known radiological sign, the Macklin effect (or pulmonary interstitial emphysema), could be a powerful predictor of subsequent development of barotrauma in patients with ARDS (sensitivity = 89.2% (95% confidence interval (CI): 74.6 to 96.9); specificity = 95.6% (95% CI: 90.6 to 98.4)). Of note, Macklin effect is visible on chest computed tomography (CT) scan 8–12 days before overt barotrauma. Furthermore, patients with Macklin effect not currently receiving invasive ventilation have a high risk of subsequent intubation. Accordingly, it could be hypothesized that Macklin effect could be a marker of lung fragility, disease severity, and P-SILI in patients with ARDS. Therefore, detection of Macklin effect on chest CT scan could be used to stratify baseline risk of patients with ARDS, select which patients should be evaluated for alternative management algorithms, including advanced respiratory monitoring, ultraprotective ventilation, or institution of extracorporeal support without invasive ventilation.


Keywords

Acute respiratory distress syndrome; Mechanical ventilation; Pneumothorax; Pneumomediastinum; Extracorporeal membrane oxygenation; Ventilator-induced lung injury; Barotrauma; Macklin effect


Cite and Share

Alessandro Belletti,Diego Palumbo,Michele De Bonis,Giovanni Landoni,Alberto Zangrillo. The role of Macklin effect in management of ARDS: beyond spontaneous pneumomediastinum. Signa Vitae. 2024. 20(11);10-14.

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