Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection

Abstract

Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.

Secondary Spontaneous Pneumothorax in a COVID-19 Recovered Patient

“…Another proposed mechanism entails pneumothorax secondary to pulmonary cyst rupture [ 13 ]. Pulmonary remodeling may develop before barotrauma from intubation or inflammatory processes such as COPD with emphysema, cystic fibrosis, tuberculosis, lung cancer, pneumocystis carinii pneumonia, lymphangioleiomyomatosis, Langerhans cell histiocytosis, and COVID-19 [ 14 , 15 ]. We also implicate the disruption of type II pneumocytes as predisposing one to spontaneous pneumothorax in COVID-19 since the virus enters cells through the angiotensin-converting enzyme-2, which is abundant in type II alveolar cells [ 16 ].…”

Pneumomediastinum and Subcutaneous Emphysema in an Adult Male From Nepal Infected With COVID-19

“…Akdogan et al reported a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Three out of five patients died, suggesting pneumothorax to be a potentially fatal complication of the COVID-19 [ 23 ].…”

Pneumothorax due to COVID-19: Analysis of case reports

“…Although the median hospital stay was 19.5 days, patients underwent invasive therapeutic methods, even though the collection of biological samples for respiratory microbiological cultures was decreased due to the risk of generating aerosols in hospital units. Therefore, the presence of infection is likely underestimated, especially due to the damage caused primarily by the virus, which promotes additional bacterial infections [ 8 ] and the formation of fibromyxoid exudates [ 73 ]. Likewise, the presence of pneumothorax has been associated with the appearance of pneumatoceles and bullae related to pneumonia, which are usually not observed in the early stages of the disease [ 56 ].…”

“…1 ). Articles and case descriptions with as much information as possible were selected for analysis; therefore, not all case studies were selected [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”