Pneumothorax and pneumomediastinum in patients hospitalized with coronavirus disease 2019 (COVID-19)

Greenberg, Daniel J.; Nabors, Christopher; Chandy, Dipak; Dhand, Abhay

doi:10.1016/j.hrtlng.2021.02.006

Cited by 7 publications

(8 citation statements)

References 4 publications

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“…Although in the present analysis these two complications did not appear to be related to the disease severity, studies on selective cohorts of invasively ventilated patients in ICU reported higher incidences (6.1–15%) [ 4 , 5 , 6 , 8 , 14 , 15 ], while in all hospitalized COVID-19 patients, lower incidences were reported (0.97–2%) [ 4 , 7 , 8 , 9 , 16 ]. Our result (4.5%) ranks in the middle, probably mirroring the heterogeneity composition of our cohort.…”

Section: Discussioncontrasting

confidence: 75%

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

Bonato

Fraccaro

Landini

et al. 2021

JCM

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Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.

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Section: Discussioncontrasting

confidence: 75%

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

Bonato

Fraccaro

Landini

et al. 2021

JCM

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“…Ekanem et al documented an SP rate of 1.4% in COVID-19 associated infection, with a strong male predominance, 9 confirmed by Greenberg et al in a more recent study. 10 These two studies included patients who were both non-ventilated and mechanically ventilated before being diagnosed with pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

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

Marza¹,

Petrică²,

Lungeanu³

et al. 2022

IJGM

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Background and Objectives: Spontaneous pneumothorax (SP) and spontaneous pneumomediastinum (SPM) have frequently been cited as complications associated with coronavirus disease 2019 (COVID-19) pneumonia, with especially poor prognosis in mechanically ventilated patients. The current literature is controversial regarding the potential risk factors for developing SP or SPM (SP-SPM) in non-ventilated COVID-19 patients. Our research addressed a twofold objective: (a) to investigate the characteristics of patients with SP-SPM (both with and without COVID-19) and compare them to patients with sole COVID-19; (b) to quantify the risk of in-hospital mortality associated with SP-SPM and COVID-19. Patients and Methods: A retrospective case-control study was conducted in the emergency departments (ED) of two tertiary hospitals in Timisoara, Romania, over one year (1st April 2020-31st March 2021; 64,845 records in total) and 70 cases of SP-SPM were identified (both SARS-CoV-2 positives and negatives). The control group comprised COVID-19 patients with no SP-SPM, included at a 2:1 ratio. Logistic regression was employed to quantify the in-hospital mortality risk associated with age, SP-SPM, and COVID-19. Results: SP-SPM and COVID-19 were connected with prolonged hospitalization, a higher percentage of intensive care admission, and a higher mortality. SP-SPM increased the odds of death by almost four times in patients of the same age, gender, smoking status, and SARS-CoV-2 infection: OR = 3.758, 95% CI (1.443-9.792). Each additional year of age added 9.4% to the mortality risk: OR = 1.094, 95% CI (1.054-1.135). Conclusion:ED physicians should acknowledge these potential risks when attending COVID-19 patients with SP-SPM.

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“…The cause of shock can also be iatrogenic; hemorrhage can result from anticoagulation therapy while pneumothorax can be caused by barotrauma or has been associated with high dose corticosteroids use. 101,102 The initial evaluation of critically ill COVID-19 patients supposedly in shock must take into consideration these potential causes. Its vasodilatory effect occurs via opening adenosine triphosphate (ATP)-sensitive K + channels in vascular smooth muscle cells leading to vasodilation.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and the cardiovascular system: an update

Salabei

Asnake

Ismail

et al. 2022

The American Journal of the Medical Sciences

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Pneumothorax and pneumomediastinum in patients hospitalized with coronavirus disease 2019 (COVID-19)

Cited by 7 publications

References 4 publications

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

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

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

COVID-19 and the cardiovascular system: an update

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