High incidence and mortality of pneumothorax in critically Ill patients with COVID-19

Abstract

Highlights Pneumothorax may be a frequent and fatal complication in critically ill patients with COVID-19. Pneumothorax was likely to occur 2 weeks after the beginning of dyspnea in senile male patients. Mechanical ventilation, recruitment maneuver, forced inhalation, severely coughing, and changes of lung structure and function, contribute to the occurrence of pneumothorax. Lung recruitment maneuver should be cautiously considered.

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

“…When taking into account critically ill COVID-19 patients, 23.8% (5/21) developed pneumothoraces indicating greater disease severity with mortality rates of 80.0% among those diagnosed. 19 These findings demonstrate that COVID-19 disease severity likely plays a vital role in explaining the high incidence of pneumothorax reported, consistent with greater IMV requirements and poor mortality rates observed.…”

“… 2 , 17 , 18 Among the two cross-sectional studies by Wang et al and Zantah et al, quality scores of six were reported. 19 , 20 …”

“… 14 , 15 , 16 , 19 , 20 According to three observational studies, less than 20% of hospitalized COVID-19 patients developed pneumomediastinum concurrently with pneumothoraces ( Table 1 ). 14 , 16 , 19 …”

“… 20 , 38 Although only two observational studies in our review described the respiratory variables involving peak inspiratory pressure, plateau pressure, PEEP, and TV among mechanically ventilated COVID-19 patients, these variables were not elevated. 19 , 20 A case series by Udi et al observed that COVID-19 patients who developed barotrauma (e.g., pneumothorax, pneumomediastinum, and subcutaneous emphysema) had lower ventilator variables of peak inspiratory pressure, plateau pressure, and TV than those who did not develop barotrauma. 26 In a similar fashion, another case series by Abdallat et al noted that critically ill COVID-19 patients receiving IMV experience a higher rate of barotrauma at a PEEP of 10-15 cmH20 as opposed to a PEEP of 15 cmH20 and more.…”

“… 19 , 36 Several studies have even noted incidental radiologic findings of cystic lung changes, including bulla before the development of pneumothorax in hospitalized patients with COVID-19 infections that is not present on admission and likely associated with the resorptive process of consolidation. 19 , 47 , 50 , 51 , 52 , 53 Similar findings are noted in observational studies of patients with influenza A pneumonia and SARS, known to cause diffuse alveolar inflammation with cysts formation regardless of IMV requirement with only inciting event for pneumothorax is forceful coughing episodes. 35 , 54 , 55 , 56 Observational study by Gattinoni et al observed that the number of bullae detected in the dependent lung regions on high-resolution chest CT was significantly higher in critically ill patients who developed pneumothoraces, and among those with ARDS and required prolong IMV.…”