Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2–5) chest radiographs and a median of one (1–2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2–21) days after arrival in the ICU and 18 (9–22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.
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Learning theories broadly characterised as constructivist, agree on the importance to learning of the environment, but differ on what exactly it is that constitutes this importance. Accordingly, they also differ on the educational consequences to be drawn from the theoretical perspective. Cognitive constructivism focuses on the active role of the learner, and on real-life learning. Social-learning theories, comprising the socio-historical, socio-cultural theories as well as the situated-learning and community-of-practice approaches, emphasise learning as being a process within and a product of the social context. Critical-learning theory stresses that this social context is a man-made construction, which should be approached critically and transformed in order to create a better world. We propose to view these different approaches as contributions to our understanding of the learning-environment relationship, and their educational impact as questions to be addressed to educational contexts.
