DOI: 10.36347/sjams.2022.v10i08.040

Pages: 1410-1413

Introduction: The new coronavirus, SARS-Cov-2, responsible for COVID-19, was identified at the end of 2019 as the agent responsible for many cases of severe respiratory failure. the treatment of patients suffering from respiratory failure due to SARS-Cov-2 pneumonia is essentially based on protective ventilatory management, which usually constitutes an essential therapeutic component in the treatment of acute respiratory distress syndrome (ARDS). However, it can be responsible for serious side effects, including pulmonary barotrauma. This observation reports an unusual appearance of barotrauma. Observation: A 65-year-old man, with a history of diabetes on oral anti-diabetics, was admitted to intensive care for treatment of severe pneumonitis due to COVID-19. The onset of the symptoms was marked by a fever of 39°C, an influenza-like illness and progressive dyspnea at rest. Biologically, the patient had lymphopenia at 640 uL, CRP at 206.74 mg/l, with a D-Dimer at 2.67 ug/l. a PCR for Covid-19 was requested, was positive. The thoracic scanner shows bilateral diffuse ground glass hyper density in the central and subpleural territories, the damage of which is estimated at 60% in favor of severe Covid-19. In arterial blood gas, chronic respiratory alkalosis with hypoxemia was observed. In view of the hypoxemic state of the patient, it was decided to put the patient on non-invasive mechanical ventilation (NIV), in spontaneous ventilation mode with inspiratory support. The patient showed clinical improvement with a respiratory rate of 18 Cyc/min and a saturation of 94% with an FiO2 of 100%. In order to limit the risk of barotrauma, protective ventilation was performed. The positive expiratory pressure (PEEP) was at 8 cmH2O with the objective of a plateau pressure <30 cmH2O with a pressure support level at 8 cmH2O to obtain a respiratory rate between 15 and 25 Cyc/min. On the fourth day of NIV, appearance of bilateral thoracic subcutaneous emphysema extending .............