High Incidence of Spontaneous Pneumothorax in Critically Ill Patients With Sars-Cov-2

Reddy, Rohit; Chen, Kai; Dewaswala, Nakeya; Tuarez, Fergie Ramos; Pino, Jesus; Martinez, Andres Chacon; Chait, Robert; Hodgin, Katherine

doi:10.1016/j.chest.2020.08.1084

Cited by 3 publications

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“…Since the data are collected based on administrative codes, it is not possible to establish whether a complication was present on admission or developed during the hospital stay. Rare complications of COVID-19 were not reported in this study [ 45 , 46 ]. Second, laboratory data and metrics like SOFA score, APACHE II, and SAPS III that have been validated to predict mortality in critically ill patients were not evaluated in our study [ 47 ].…”

Section: Discussionmentioning

confidence: 90%

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

et al. 2022

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Background The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA. Methods We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021. Results Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave. Conclusions Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.

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Section: Discussionmentioning

confidence: 90%

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

et al. 2022

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“…In a study 13 of 22 patients with confirmed SARS-CoV-2 infection on mechanical ventilation, 7 patients developed spontaneous pneumothorax. Chronic obstructive pulmonary disease was not present in any of the patients.…”

Section: Ventilator Setting Patient S Efforts As Other Possible Etiologies Of Air Leakmentioning

confidence: 99%

“…Median tidal volume (VT) was 6.1 mL/kg predicted body weight on day 1, and the value increased significantly up to day 7, positive end-expiratory pressure was 10 cmH2O (8)(9)(10)(11)(12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was 160 [interquartile range (IQR) 111-218], respiratory system compliance 36 mL/cmH2O (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), driving pressure 12 cmH2O (10)(11)(12)(13)(14), and FiO2 0.60 (0•45-0•80) on day 1. Acute respiratory distress syndrome developed in 1672 (87.6%) of patients.…”

Section: Introductionmentioning

confidence: 99%

Alveolar air leak and paraseptal emphysema in severe COVID-19 disease

Najafi¹,

Fallahian²,

Ahmadi³

et al. 2021

JMV

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Background Corona virus 2019 (COVID-19) pandemic spread in the world as a great medical crisis. Its pathophysiology, manifestations, complications, and management are not completely defined, yet. In this study frequency of alveolar air leak in critically ill COVID-19 subjects is explored. Methods A total of 820 critically ill COVID-19 subjects who admitted with respiratory insufficiency to ICUs of Sina University Hospital from March 2020 to June 2021 were included. All their chest x ray (CXR) and Computed tomography (CT) of chest were reviewed. All alveolar air leak episodes (pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema) suspected films reviewed by attending intensivist and radiologist. Results Of the 820 ill COVID-19 subjects in ICUs, 492(60%) were male, and 328 (40%) were female. The Mean age of 820 subjects was 60.84 + 16.82. 584 (71.22%) of subjects were non-intubated, and 236 (28.78%) were intubated. Alveolar air leak occurred in 98 (11.95%) of subjects. Alveolar air leak episodes include pneumothorax in 26 (3.17%), subcutaneous emphysema in 72 (8.78%), pneumomediastinum in 9 (1.10%), and pneumopericardium in 1 (0.12%) of subjects. The mean age in non-intubated subjects was 59.65 + 16.84, and for intubated subjects was 63 + 16.42. There was a significant difference in age between the groups who get intubated, versus not intubated P 0.001. Of the 584 non-intubated subjects, 31 (5.31%) had subcutaneous emphysema, of the 236 intubated subjects, 41 (17.37%) had subcutaneous emphysema. Difference between groups was statistically significant, P <0.001. When we compared intubated and non-intubated patients in case of total numbers of alveolar air leak episodes, the difference was statistically significant P <0.001. Conclusion According to this study, intubation was implemented more in older patients. Also, invasive ventilation was significantly associated with subcutaneous emphysema and total number of alveolar air leak episodes. In every patient with exaggeration of hypoxia, dyspnea or chest pain, pneumothorax should be kept in mind as a differential diagnosis. Keywords: COVID-19; Respiratory failure; Alveolar air leak; Paraseptal emphysema

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“…Email:amahmoodpoor@yahoo.com patients exhibit mild symptoms and have a good prognosis, this disease may lead to life-threatening conditions. [5][6][7][8] Pneumothorax, tension pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema are uncommon clinical manifestations in patients with COVID-19. These patients experience spontaneous pneumothorax more commonly (0.57%) than other critical patients.…”

Section: Introductionmentioning

confidence: 99%

“… 1 The odds of developing spontaneous pneumothorax is 40 to 100 times higher in patients with COVID-19 compared to those without, and mechanical ventilation increases the risk of pneumothorax in COVID-19 patients. 5 , 6 According to a study, the pathophysiology of pneumomediastinum in COVID-19 patients can be explained by the Macklin effect. 7 The Macklin effect starts with alveolar rupture secondary to direct alveolar injury, leading to air leaking and dissection along the bronchovascular sheaths and eventually spreading of air within the mediastinum.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review

et al. 2022

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Objectives: COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients. Methods: The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion. Results: A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients’ death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001). Conclusion: With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn’t find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies’ design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes› incidence, risk factors, and outcomes in COVID-19 patients. doi: https://doi.org/10.12669/pjms.38.3.5529 How to cite this:Shahsavarinia K, Rahvar G, Soleimanpour H, Saadati M, Vahedi L, Mahmoodpoor A. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5529 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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High Incidence of Spontaneous Pneumothorax in Critically Ill Patients With Sars-Cov-2

Cited by 3 publications

References 0 publications

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Alveolar air leak and paraseptal emphysema in severe COVID-19 disease

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review

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