Incidence, Management, and Outcomes of Patients With COVID-19 and Pneumothorax

Abstract

BACKGROUND Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19).METHODS A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Secondarily, we analyzed clinical outcomes of patients requiring tube thoracostomy, including those requiring operative intervention.

Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report

“…Previous retrospective and observational studies have shown that the incidence of pneumothorax is 1% in patients with COVID-19 pneumonia who need hospitalization, 2% in those who need intensive care treatment, and 5.9–15% in those receiving IMV ( 3 – 5 ). In a recent retrospective review examining 1,595 patients with COVID-19, pneumothorax occurred in 7% of patients, among whom IMV-related pneumothorax was diagnosed in 80% ( 1 ). Another retrospective study that examined 601 patients with COVID-19 pneumonia requiring IMV also supported the above epidemiological findings ( 4 ).…”

“…Interestingly, pneumothorax occurs spontaneously in patients with COVID-19 pneumonia even in the absence of pre-existing lung disease or the need for IMV ( 6 ). Approximately 20% of patients with COVID-19 develop ARDS, which requires IMV ( 1 ). Given the high incidence rate of pneumothorax complicated by COVID-19-related ARDS, early detection and management of COVID-19-related pneumothorax is essential.…”

“…Given the high incidence rate of pneumothorax complicated by COVID-19-related ARDS, early detection and management of COVID-19-related pneumothorax is essential. While most cases of COVID-19-related pneumothorax resolve spontaneously or require chest tube drainage ( 1 ), some cases of refractory pneumothorax with PALs, secondary to COVID-19, eventually required thoracic surgery ( 7 – 9 ). However, COVID-19-related PALs pose diagnostic and therapeutic challenges.…”

“…A retrospective single-center study reported the details of the management and outcomes of COVID-19 complicated by pneumothorax ( 1 ). Patients having COVID-19 combined with pneumothorax were significantly associated with higher rates of in-hospital mortality than those without pneumothorax (58 vs. 13%, p < 0.001).…”

“…It is a known sequela of COVID-19. The association between COVID-19 and pneumothorax development has recently gained attention because of the latter’s association with prolonged hospitalization and increased in-hospital mortality ( 1 ). Pneumothorax is a common complication strongly associated with barotrauma during invasive mechanical ventilation (IMV) ( 2 ).…”