Spontaneous pneumomediastinum incidence and clinical features in non-intubated patients with COVID-19

Haberal, Miktat Arif; Akar, Erkan; Dikiş, Özlem Şengören; Ay, Mehmet Oğuzhan; Demirci, Hakan

doi:10.6061/clinics/2021/e2959

Cited by 9 publications

(9 citation statements)

References 20 publications

(18 reference statements)

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“…Haberal et al also described cases of spontaneous PM in COVID-19 who also were not receiving mechanical ventilation at the time of an event [14]. They reported seven cases out of 38,492 patients who presented to the emergency department with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Secondary Spontaneous Pneumomediastinum and Pneumothorax in Severe COVID-19 Pneumonia

Staiano¹,

Patel²,

Green³

et al. 2022

Cureus

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IntroductionPneumomediastinum and pneumothorax are uncommon complications in COVID-19 patients. The exact prevalence, etiology, and outcomes are not well known. We report a case series of patients in our institution with COVID-19 related pneumomediastinum and pneumothorax and address these questions. MethodsWe conducted a single-center retrospective chart review of patients admitted at our institution with a positive polymerase chain reaction (PCR) confirming the diagnosis of COVID-19. A cohort of 500 potential study candidates was identified, of whom eight were investigated. Demographic data, hospital course, patient co-morbidities, and outcome data were collected. ResultsEight patients were included in our study who were identified as having an event (i.e., pneumomediastinum and/or pneumothorax) during the specified timeframe. Overall, 62% of patients were on high-flow nasal cannula with an average FiO 2 of >70%. The average oxygen saturation//fraction of inspired oxygen (SpO 2 /FiO 2 ) ratio leading up to an event was 113.7286 (range: 101.11-130.66), and all of the patients not on mechanical ventilation met the criteria for acute respiratory distress syndrome (ARDS) based on the Kigali definition with SpO 2 /FiO 2 < 315. The three patients who developed an event while requiring mechanical ventilation both had PaO 2 /FiO 2 < 100, consistent with severe ARDS at the time of an event. The mean time in days, counted from the day of hospital admission until an event, was 10 days (range: 3-23 days). None of the cases had documented pulmonary parenchymal disease prior to developing COVID-19. To the best of our knowledge, these events were not iatrogenic in nature. ConclusionSecondary spontaneous pneumomediastinum and pneumothorax are rare albeit well-documented phenomena in hospitalized patients with COVID-19 infection. Interestingly, the majority of patients in our study were on high-flow nasal cannula at the time of an event. The majority of previously published data on this topic are on those who required positive pressure ventilation; however, there have been more recent papers that also describe these events in non-mechanically ventilated patients. The exact pathophysiology remains unknown, but it is likely multifactorial, and additional studies are needed to further evaluate this phenomenon.

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Section: Discussionmentioning

confidence: 99%

A Case Series of Secondary Spontaneous Pneumomediastinum and Pneumothorax in Severe COVID-19 Pneumonia

Staiano¹,

Patel²,

Green³

et al. 2022

Cureus

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“…Se ha observado una incidencia de NMMD considerable en los pacientes hospitalizados con neumonía por SARS-CoV-2, la cual oscila generalmente entre el 0,64% (377/58.484) 9 y el 1,5% (87/5.687) 10 , aunque se han registrado frecuencias más alejadas, desde un 0,33% (11/3.377) 11 hasta un 3,2% (66/2.046) 7 . Si nos circunscribimos al NMMD de origen espontáneo en la COVID-19, se encontraron incidencias del 0,43% (8/1.845) 12 al 0,57% 13 , pasando entre medias por 0,51% (5/976) 14 , y llegando en algunos estudios a valores extremos de 0,01818% (7/38.492) 15 y 3,32% (9/271) 16 . En cualquier caso, se trata de una incidencia muy superior en comparación con la incidencia de NMMD espontáneo en la población general, que oscila entre 1/42.000 (0,00238095%) y 1/800 (0,125%) 1,2,4,5 .…”

Section: Epidemiología Del Neumomediastino En La Covid-19unclassified

“…Sin embargo, el barotrauma no es una condición necesaria para que pueda producirse NMMD. De hecho, muchos pacientes con neumonía por SARS-CoV-2 que desarrollaron NMMD no habían requerido de ventilación mecánica previamente a la aparición del NMMD, por lo que en estos el barotrauma no pudo intervenir de ninguna manera en el desarrollo del NMMD (NMMD espontáneo) 12,[14][15][16][30][31][32][33]38,39 .…”

Section: Nmmd Solounclassified

“…desarrollan NMMD/NMTX con una frecuencia considerablemente mayor 11,27,28 a los pacientes receptores de SRNI (GNAF, CPAP, BPAP) 9,11,22,23,[27][28][29][35][36][37] , seguido de los pacientes sin necesidad de VMI ni SRNI (NMMD y NMTX espontáneos), es decir, con necesidad de oxigenoterapia estándar o sin necesidad de oxigenoterapia alguna [12][13][14][15][16] . Asimismo, recalquemos que el factor más destacado que puede conducir a la aparición de NMMD es la «fragilidad pulmonar» derivada de la neumonía por SARS-CoV-2 y el SDRA asociado 25,26 .…”

Section: A B C D E Funclassified

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El neumomediastino como complicación de la neumonía por SARS-CoV-2

Lorente-González¹,

Terán-Tinedo²,

Zevallos-Villegas³

et al. 2023

RPR

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La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la población general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento del gradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobre unos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo lo cual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía por SARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes con neumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensivos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, el neumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que se resuelve con tratamiento conservador.

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“…[4][5][6] The incidence of pneumomediastinum in patients with COVID-19 is higher (1:5498) than in the general population (1:7000 to 1:45,000). 7,8 Patients with pneumomediastinum had evidence of increased disease severity at admission. 9 A meta-analysis by Shrestha et al in 2022 revealed a linear relationship between the incidence of pneumomediastinum and disease severity.…”

Section: Introductionmentioning

confidence: 99%

Pneumomediastinum in COVID‐19 disease: Clinical review with emphasis on emergency management

et al. 2023

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Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non‐traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID‐19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID‐19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID‐19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID‐19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life‐saving interventions for tension pneumomediastinum.

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Spontaneous pneumomediastinum incidence and clinical features in non-intubated patients with COVID-19

Cited by 9 publications

References 20 publications

A Case Series of Secondary Spontaneous Pneumomediastinum and Pneumothorax in Severe COVID-19 Pneumonia

A Case Series of Secondary Spontaneous Pneumomediastinum and Pneumothorax in Severe COVID-19 Pneumonia

El neumomediastino como complicación de la neumonía por SARS-CoV-2

Pneumomediastinum in COVID‐19 disease: Clinical review with emphasis on emergency management

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