Clinical Course of Mechanically Ventilated COVID-19 Patients With Pneumothoraces

Abstract

IntroductionPneumothoraces in mechanically ventilated patients with COVID-19 indicate severe lung damage from inflammatory injury and barotrauma. These patients have a high mortality rate, and additional factors may further alter their clinical course. MethodsWe conducted a retrospective review of patients admitted to 11 public hospitals in New York City between March 6 and April 9, 2020, diagnosed with COVID-19. We identified 39 patients who developed pneumothoraces immediately after intubation or after a period of time on mechanical ventilation. Our study population was divided into various groups using demographic and clinical characteristics. Statistical analyses were conducted using SPSS software (IBM Inc., Armonk, USA) and paired t-tests to compare clinical outcomes between the various groups. P values < 0.05 were considered statistically significant. ResultsOur population was comprised of 28 male (72%) and 11 female patients; 36 out of 39 patients (92.3%) died with a median time of 10 days from admission to death and a median time of 2 days from pneumothorax to death. The remaining three were discharged home or to another facility. Pneumothoraces developed immediately after intubation in 18 patients and after a period of time on mechanical ventilation in 21 patients. Factors associated with a worse clinical course included age greater than 65 years (time from admission to pneumothorax 4.81 vs 8.35 days; p = 0.011) and presence of one or more comorbidities (time from admission to intubation 2.3 days vs 4.8 days; p = 0.041). Other factors that may worsen clinical course include previous smoking (time from admission to pneumothorax 4.4 vs 8.54 days; p = 0.074) and use of positive end-expiratory pressure (PEEP) greater than 15 cm H 2 O (time from intubation to pneumothorax 3.89 vs 6.42 days; p = 0.14). ConclusionsBased on the findings in our retrospective review, COVID-19 patients who develop pneumothoraces on mechanical ventilation have a mortality rate in excess of 90%. Older patients and those with comorbidities have a more fulminant clinical course.

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

“…Barotrauma was a relatively common finding in patients with COVID-19 pneumonia during the pandemic, which was either P-SILI or ventilator-induced (invasive or non-invasive) [24,25]. Many researchers suggested that spontaneous pneumothorax was possible in patients with high C-reactive protein, severe lymphopenia, high D-dimer, high lactate dehydrogenase and ferritin, or high viral load [26,27].…”

Pneumothorax in Intubated Patients With COVID-19: A Case Series

“…All of our patients however suffered from severe ARDS due to COVID-19 pneumonia and hence severe lung inflammation, setting up an optimal environment for the pathogenesis of pneumothorax. There have been many other case reports/series, retrospective cohort studies, and meta-analyses that have highlighted this phenomenon of pneumothorax and pneumomediastinum in COVID-19 patients [1][2][3][4][5][6][7][8][9][10][11][12]. It is said that 1% of all patients develop pneumothorax with COVID-19, although almost 7.5% of patients who are admitted develop pneumothorax with a mortality rate of about 58%.…”