Pneumothorax/pneumomediastinum and pre-existing lung pathology in ventilated COVID-19 patients: a cohort study

Abstract

Background: There is an increasing number of reports on developing pneumothorax/pneumomediastinum among severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) patients. The aim of our study was whether pre-existing diffuse lung pathology increases visceral pleural vulnerability resulting in pneumomediastinum and pneumothorax among mechanically ventilated COVID-19 patients? Methods: A total of 138 consecutive COVID-19 patients admitted to the Intensive Care Unit of Petz Aladár University Teaching Hospital between 1st March 2020 and 1st February 2021 were included.Sixty/138 (43.48%) patients had one or more computer tomography scans of the chest. Analysis was focused on the image defined lung conditions during artificial ventilation.Results: Thirteen out of 60 ventilated patients developed pneumothorax or pneumomediastinum proven by computer tomography (9.42%). Three/13 patients suffered from pre-existing lung parenchyma pathology, while 10/13 had only COVID-19 infection-related image abnormality. Forty-three/60 patient had healthy lung pre-COVID. Kruskal-Wallis test, Spearman correlation and Cox regression calculations did not reveal any statistically significant result proving increased vulnerability during pressure support therapy and visceral pleural breakdown in patients with pre-existing lung pathologies.Conclusions: Pre-existing lung pathology does not increase the risk of onset of pneumothorax or pneumomediastinum in comparation with previously healthy lungs of ventilated COVID-19 patients.

COVID-19-Related Pleural Diseases

“…6 Some studies have reported that up to 70% of patients did not have any underlying respiratory disease. 4 16 The use of corticosteroid therapy for COVID-19 was not found to be an independent risk factor for PTX development. 6…”

“…6 Some studies have reported that up to 70% of patients did not have any underlying respiratory disease. 4,16 The use of corticosteroid therapy for COVID-19 was not found to be an independent risk factor for PTX development. 6 Influenza-A infection) have demonstrated similar or related pathophysiological processes leading to PTX but mostly in the context of MV.…”

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

“…ventilation in patients with ARDS receiving high positive pressure ventilation (PPV) [110][111][112][113][114][115][116]. Pneumothorax (PNX) was found to co-exist with PMS in 40.3% of cases [110].…”

A pneumothoraxról: Szövetségesből ellenség •

“…Hasonlóképpen a katameniális PTX rekeszi áteresztő szigetein felkerülő levegő volumene meg kell hogy haladja a pleurafelszín élettani levegőfelszívó kapacitását (1-2 mm/24h). A pozitív végnyomással lélegeztetett betegnél kialakuló feszülő légmell tüdő és következményes visceralis pleura sérülés következménye [22].…”

“…A consolidalt tüdő feletti pleuraűr viselkedésének meg nem értéséből fakadt a Covid-19 pneumoniák kapcsán tapasztalt (rendszerint intenzíves nyomás alatti) szívókezelési furor, különösen a mediastinalis légmellek kapcsán [22].…”