Spontaneous pneumomediastinum in COVID-19 pneumonia

Loffi, Marco; Regazzoni, Valentina; Sergio, Pietro; Martinelli, Enrico; Stifani, Italo; Quinzani, Filippo; Robba, Debora; Cotugno, Annunziata; Dede, Meghi; Danzi, Gian Battista

doi:10.4081/monaldi.2020.1399

Cited by 25 publications

(30 citation statements)

References 6 publications

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“…There are isolated reports of PNX/PMD as a complication of COVID-19 ARDS. 13 , 14 , 15 , 16 , 17 However, currently, there are few published data on the incidence and outcome of these complications in this specific patient population. 18 Furthermore, early predictors of PNX/PMD remain poorly described.…”

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confidence: 99%

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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Objective To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design Observational study. Setting Tertiary-care university hospital. Participants One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. Interventions The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. Measurements and Main Results PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). Conclusion PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.

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confidence: 99%

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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“…The presence of spontaneous pneumomediastinum in COVID-19 was associated with severe clinical course requiring aggressive management in a retrospective analysis by Loffi et al in a tertiary care center in Northern Italy which was the first European area to be hit by COVID-19 [ 24 ]. Wang et al performed a retrospective analysis of 248 COVID-19 patients and found the incidence of pneumothorax to be 24% in those with mechanical ventilation, the overall incidence was 2.01% and incidence in patients with ARDS was 10%.…”

Section: Discussionmentioning

confidence: 99%

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

Kafle¹,

Shrestha²,

Pokharel³

et al. 2021

Cureus

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Pneumomediastinum and subcutaneous emphysema have been reported in COVID-19 around the world except for Nepal. We report a case of a 44-year-old male infected with COVID-19 who developed pneumomediastinum and subcutaneous emphysema during his eighth day of intubation at the hospital. He was managed with remdesivir, antibiotics, mechanical ventilation, steroid, and heparin following which he recovered well. Barotrauma-related complications are common in COVID-19 and our case highlights the importance of conservative management for such complications and the rarity of such conditions in Nepal.

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“…The exact mechanism of SP in non-ventilated patients remains unknown. However, the Macklin effect has been proposed as a possible etiology [3] owing to the SARS-CoV-2 propensity to damage type 2 pneumocytes [4]. The Macklin effect starts with alveolar rupture secondary to direct alveolar injury, leading to air leaking and dissection along the bronchovascular sheaths and eventually spreading of air within the mediastinum [5].…”

Section: Discussionmentioning

confidence: 99%

“…Due to unreliable sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR), chest X-ray (CXR) and high-resolution computed tomography (HRCT) chest are often used to support a diagnosis and gauge severity in COVID-19 infection [2]. HRCT can show parenchymal changes ranging from ground-glass opacities to widespread consolidation [3]. Seldom have some extra-parenchymal findings such as pneumomediastinum been reported.…”

Section: Introductionmentioning

confidence: 99%

The Macklin Effect in COVID-19

Iqbal¹,

Malik²,

Chaudhry³

2021

Cureus

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From the mere outlook of the ongoing pandemic, coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) seems to target mainly the respiratory system, but more evolving evidence has advocated its multi-organ involvement. While various complications have been reported in coronavirus disease 2019 (COVID-19) patients, spontaneous pneumomediastinum (SP) remains an uncommon complication.

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Spontaneous pneumomediastinum in COVID-19 pneumonia

Cited by 25 publications

References 6 publications

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

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

The Macklin Effect in COVID-19

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