Pneumothorax in Critically Ill COVID-19 Patients: Prevalence, Analysis of Risk Factors and Clinical Outcomes

Abstract

Background: Previous studies have been conducted to assess pneumothorax. However, few studies were done to assess pneumothorax in COVID-19 patients in the intensive care unit (ICU). Objective: Our aim is to describe and analyze the prevalence, clinical characteristics, risk factors, and outcomes of COVID-19 pneumothorax patients in the intensive care unit. Methods: We performed a retrospective review of the medical records of 418 patients, who tested positive for COVID-19 by polymerase chain reaction test and required ICU admission in King Fahad Hospital of The University from 02/01/2020 to 01/09/2021. A total number of 36 pneumothorax patients were included in the study. Results: Of 418 patients who were followed up in the intensive care unit as COVID-19 cases, 36 patients developed a pneumothorax (8.61%). The mean age of the patients was 55.6 ± 15.06 years, 23 patients were male, and 13 were female. Seventeen patients were obese, and only one patient was an active smoker. Twenty-four patients had at least one comorbidity; hypertension was the most common. Thirty-two patients were intubated, and the duration of intubation was 23.23 ±15.9 days. The time from intubation to pneumothorax development was 8.8 ± 9.3 days. Six patients were on bilevel positive airway pressure ventilation (BIPAP), 2 patients on continuous positive airway pressure ventilation (CPAP), 3 patients on High-Flow Nasal Cannula ventilation (HFNC), 9 patients on pressure-control ventilation (PC), and 16 patients on pressure regulated volume control ventilation (PRVC). Of 36 patients, 26 died, and the mortality rate was 72.2%. Conclusion: Our study showed that risk factors of pneumothorax occurrence in COVID-19 critically ill patients include male patients, hypertension, diabetes mellitus, endotracheal intubation and mechanical ventilation. More efforts should be made to determine the risk factors and assess the outcomes of those patients to develop preventive measures and management guidelines.

Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study

“…The incidence of PTX/PM in our study was 3 %, lower than most reports in COVID-19 [ 43 , 44 ]. However, the reported frequency of PTX has risen over the course of the pandemic, due to different virus variants [ 44 ].…”

Evolving Clinical Manifestations and Outcomes in COVID-19 Patients: A Comparative Analysis of SARS-CoV-2 Variant Waves in a Romanian Hospital Setting

“…Similarly, in our study, as presented in Table 2, the in-hospital mortality rate in patients that developed barotrauma exceeded ten times the overall mortality rate (61.42%; OR = 25.1). AlGhamdi et al found that the male gender, hypertension, diabetes, endotracheal intubation, and mechanical ventilation were risk factors for PNX [24]. Our multivariate analyses found the following risk factors for PNX/PNMD: age over 65 years, pulmonary comorbidities, and infection during the Alpha and Delta waves (Table 5).…”