COVID-19 pneumothorax in the UK: a prospective observational study using the ISARIC WHO clinical characterisation protocol

Abstract

Pneumothorax is an important complication of COVID-19 [1, 2]. Based on a series of 60 individuals, we previously estimated that 0.91% of people admitted to hospital with COVID-19 develop pneumothorax [1]. Males accounted for three quarters of those affected, and patients requiring non-invasive or invasive ventilatory support appeared at elevated risk. In a separate series of ventilated patients with COVID-19, barotrauma, defined as pneumothorax or pneumomediastinum, was found to be an independent risk for death [2]. During the pandemic, treatment strategies have evolved, influenced by large randomised controlled trials and clinical experience. Following the landmark results from the RECOVERY trial [3], dexamethasone became standard of care for patients requiring supplemental oxygen. Following the first UK wave between March to June 2020, use of non-invasive respiratory support became more common [4, 5]. Such changes could plausibly alter the incidence of pneumothorax caused by COVID-19. Indeed, a recent small study reported an increase in pneumothoraces in the second wave of COVID-19 in Italy, speculating that dexamethasone use might have been causal [6].

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

“…As a demonstration of the impact of these complications of COVID-19, numerous studies have been published on this topic since the pandemic outbreak, but only nine included a large number of patients, and only two included a control group (4). The results of a recently published study considering more than 130,000 hospitalized COVID-19 patients in the United Kingdom (8) are in line with the present study. However, there are some differences with previous works that have to be highlighted.…”

“…Moreover, in our study, these results have been shown to be independent of age, sex, and the severity of the disease based on the P/F ratio and the need for respiratory support. Many studies reported similar results in both invasively and non-invasively ventilated patients [7,8,10,14], although not all studies assessed…”

“…Moreover, in our study, these results have been shown to be independent of age, sex, and the severity of the disease based on the P/F ratio and the need for respiratory support. Many studies reported similar results in both invasively and non-invasively ventilated patients [ 7 , 8 , 10 , 14 ], although not all studies assessed the same outcomes [ 4 , 6 , 7 ]. In particular, Martinelli et al [ 7 ] observed that the occurrence of PNX/PNM worsened the prognosis in older subjects, while we did not observe such age-related differences in our cohort.…”

“…Several case series and studies, some of them included in a recent systematic review [4], investigated these complications in hospitalized COVID-19 patients, highlighting the occurrence of PNX/PNM also in COVID-19. However, their effective incidence and their influence on disease outcome are still debated [5][6][7][8]. A retrospective study reported an overall incidence of PNX/PNM of 0.54% in COVID-19 patients at emergency department admission [9], while an incidence of 6.1-15% has been reported by studies conducted in invasively ventilated patients [5][6][7][8]10].…”

“…However, their effective incidence and their influence on disease outcome are still debated [5][6][7][8]. A retrospective study reported an overall incidence of PNX/PNM of 0.54% in COVID-19 patients at emergency department admission [9], while an incidence of 6.1-15% has been reported by studies conducted in invasively ventilated patients [5][6][7][8]10]. These studies reported that COVID-19 is burdened by a higher incidence of PNX/PNM than the general population [6,9].…”