Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study

Abstract

Background The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax has not been rigorously described or compared to those who do not develop a pneumothorax. Purpose To determine the incidence, clinical characteristics, and outcomes of critically ill patients with COVID-19 infection who developed pneumothorax. In addition, we compared the clinical characteristics and outcomes of mechanically ventilated patients who developed a pneumothorax with those who did not develop a pneumothorax. Methods This study was a multicenter retrospective analysis of all adult critically ill patients with COVID-19 infection who were admitted to intensive care units in 4 tertiary care centers in the United States. Results A total of 842 critically ill patients with COVID-19 infection were analyzed, out of which 594 (71%) were mechanically ventilated. The overall incidence of pneumothorax was 83/842 (10%), and 80/594 (13%) in those who were mechanically ventilated. As compared to mechanically ventilated patients in the non-pneumothorax group, mechanically ventilated patients in the pneumothorax group had worse respiratory parameters at the time of intubation (mean PaO 2 :FiO 2 ratio 105 vs 150, P<0.001 and static respiratory system compliance: 30ml/cmH 2 O vs 39ml/cmH 2 O, P=0.01) and significantly higher in-hospital mortality (63% vs 49%, P=0.04). Conclusion The overall incidence of pneumothorax mechanically ventilated patients with COVID-19 infection was 13%. Mechanically ventilated patients with COVID-19 infection who developed pneumothorax had worse gas exchange and respiratory mechanics at the time of intubation and had a higher mortality compared to those who did not develop pneumothorax.

Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

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We read with great interest the article by Chopra et al recently published on Respiratory Medicine [1].In their multicenter study, the Authors present incidence, clinical characteristics and outcome of pneumothorax in critically ill patients with coronavirus disease 2019 . They found that pneumothorax rate among invasively ventilated COVID-19 patients is 80/594 (13 %), and mortality rate for patients who developed pneumothorax is 50/80 (62 %).

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“…We read with great interest the article by Chopra et al recently published on Respiratory Medicine [1].…”

Pneumothorax due to COVID-19: Analysis of case reports

“…Wang, in a series of 248 COVID-19 cases, reported that 2% of patients presented pneumothorax, which increased to 80% when ARDS was present; therefore, in that series, 80% of patients died [ 71 ]. The presence of pneumothorax with COVID-19 was diagnosed in 92% of patients who underwent invasive mechanical ventilation and in 13.72% of those who presented ARDS [ 78 ]; as well as in a multicenter retrospective analysis of all adult critically ill patients with COVID-19 infection, the overall incidence of pneumothorax in mechanically ventilated patients with COVID-19 infection was 13% [ 81 ]. In a retrospective study in China, pneumothorax occurred in 1% of patients [ 14 ].…”

COVID-19-Associated Pneumomediastinum: An Emerging Clinical Presentation

“…Some authors have linked this association to the high levels of mechanical ventilation used in patients with severe COVID-19 disease. Patients with COVID-19 have a significantly elevated risk of pneumomediastinum and pneumothorax; the incidence of pneumothorax in mechanically ventilated patients with COVID-19 has been estimated to be 13% [6]. However, an analysis that compared cohorts of COVID-19 patients with non-COVID-19 patients on ventilation showed that patients with COVID-19 have a significantly higher incidence of pneumomediastinum compared to other ventilated patients with acute respiratory distress syndrome (13.6% vs. 1.9%), suggesting that coronavirus infection may have a causal role [7].…”

“…Despite the increased medical concern caused by a diagnosis of pneumomediastinum associated with COVID-19 pneumonitis, most cases can be managed conservatively with a good outcome and gradual resorption of air back into tissues [9]. However, further investigations may be warranted to rule out pneumothorax in these patients, which is clearly associated with worse outcomes [6].…”