Management of spontaneous pneumothorax in patients with COVID-19

Abstract

OBJECTIVES The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. METHODS We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. RESULTS Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups. CONCLUSIONS The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.

Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection

“…Its prevalence, risk factors, and final outcome remain unclear. 13,14,[30][31][32][33][34][36][37][38][39] Our research contributes to understanding the combination of SP, SPM and COVID-19 in non-ventilated patients, and quantifying their associated risks for in-hospital mortality.…”

“…29 Also, microvascular thrombosis and the cytokine storm were associated with more severe forms of the disease and considered main contributors of such complications. 29,31 Other important chest CT or X-ray findings were pulmonary interstitial infiltrates, identified mainly in SP-SPM cases with COVID-19, compared to non-COVID-19 cases (46.7% vs 15%, respectively). Pathological findings, such as early fibrosis, cyst formation, traction and air-leak described in the evolution of COVID-19 patients, were reported as related to the SP development.…”

“…29 The presence of pneumothorax in patients with Middle East respiratory coronavirus syndrome (MERS) or H1N1 was shown to be a negative prognostic factor. 31,35 Taking all of the above into consideration, the association of SP-SPM with COVID-19 might still be underreported. Its prevalence, risk factors, and final outcome remain unclear.…”

Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances

“…A spontaneous pneumothorax (SP) describes the movement of air from the lung into the pleural cavity in the absence of trauma. A secondary spontaneous pneumothorax (SSP), as opposed to a primary spontaneous pneumothorax (PSP), refers to a SP in a patient with underlying chronic lung disease such as chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), cystic fibrosis or lung cancer, or acute conditions, such as Pneumocystic jirovecii pneumonia (PJP) or COVID-19 pneumonitis [ 1 , 2 ]. SSPs are more common than PSPs, with recent English SP epidemiological data demonstrating over 60% are due to SSPs.…”

Forensic and Pharmaceutical Risks in the Organization of Pharmacotherapy of Covid, Post-Covid and Long-Covid Disorders. COVID-19 and Vaccination Practice Standards.

“…From 10 to 30% of annual cases of acute respiratory viral infections can be caused by coronaviruses. Coronaviruses can cause diseases of varying degrees of severity in people: from common colds to more severe ones [20].…”