Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review

Abstract

Background: Cases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation.Methods: A PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed.Descriptive statistics were used to synthesize results.Results: There were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved.Discussion: Even if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized.Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.

Risk factors of pneumothorax and pneumomediastinum in COVID-19: a matched case–control study

“…While PNX/PNM due to COVID-19 has been primarily reported in patients who are on IMV support, a small number patients who are not on IMV support have also been found to develop PNX/PNM [24,25]. Despite a lower prevalence of PNX/PNM in patients who are not on IMV support, 6 of 233 with NIAID-OS scores of 5-6 developed PNX/PNM in our study.…”

The Collateral Damage of the Pandemic on Non-COVID Related Pneumothorax Patients: A Retrospective Cohort Study

“…Although there are several studies regarding the pneumothorax of COVID-19 patients [11,[15][16][17], to the best of our knowledge, studies describing the impact of the pandemic on non-COVID-19-related pneumothorax patients are lacking. We tried to fill this gap and evaluated the impact of the pandemic on non-COVID-related pneumothorax.…”

Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report

“…Among patients requiring IMV, the frequency of barotrauma in the group with COVID-19 pneumonia was significantly higher than in the non-COVID-19 group (15 vs. 0.5%, p < 0.001), and in those with ARDS prior to the COVID-19 pandemic (15 vs. 10%, p < 0.001). Interestingly, pneumothorax occurs spontaneously in patients with COVID-19 pneumonia even in the absence of pre-existing lung disease or the need for IMV ( 6 ). Approximately 20% of patients with COVID-19 develop ARDS, which requires IMV ( 1 ).…”