Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Manna, Sayan; Maron, Samuel Z.; Cedillo, Mario A.; Voutsinas, Nicholas; Toussie, Danielle; Finkelstein, Mark; Steinberger, Sharon; Chung, Michael; Bernheim, Adam; Eber, Corey; Gupta, Yogesh Sean; Concepcion, Jose; Libes, Richard; Jacobi, Adam

doi:10.1016/j.clinimag.2020.08.013

Cited by 64 publications

(76 citation statements)

References 37 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study found that NIV failed in preventing mechanical ventilation in 38% as compared with 28% in a study by Manna et al who reported that patients who failed NIV were older, had a higher respiratory rate, PaCO2 and D-dimer levels before NIV, and higher minute ventilation and ventilatory ratio on the first day of NIV [ 22 ]. In our study, patients receiving HFNC were few in number, and since we employed an HFNC/NIV alternating strategy on most patients, comparison between the two modalities was not feasible.…”

Section: Discussionmentioning

confidence: 78%

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan

Baqi¹,

Naz²,

Sayeed³

et al. 2021

Cureus

View full text Add to dashboard Cite

Introduction: In Pakistan, the first case of COVID-19 was reported in February of 2020, cases peaked in June, and by January 2021, approximately 500,000 confirmed cases and over 10,000 deaths have been reported. There is a lack of data in Pakistan of the demographics, clinical characteristics, and outcome of patients with COVID-19 pneumonia, particularly those with severe illness, which we aim to assess. Methods: This is a single-centered, observational study conducted at the COVID unit of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma in Karachi, Pakistan. A manual medical record review of patients admitted from April 24, 2020 to August 24, 2020 was conducted, and all patients with polymerase chain reaction (PCR) positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) with moderate, severe, and critical COVID-19 pneumonia were included. Results: Of 299 patients, the median age was 60 years (50-65). Males accounted for 221 (73.9%). Most common symptoms were shortness of breath seen in 270 (90.3%) and fever in 225 (75.3%) patients. Diabetes mellitus (51.2%) and hypertension (50.3%) were the predominant co-morbidities. COVID disease was categorized on admission as moderate in 68 (22.7%), severe in 151 (50.5%), and critical in 80 (26.8%) patients. Survival analysis was done in 252 patients, all of whom received steroids, while tocilizumab was administered to 111 (44%) patients. Hundred (39.7%) patients received non-invasive ventilation (NIV), while 57 (22.6%) were placed on mechanical ventilation. Overall, 95 (37.7%) patients died. Factors associated with mortality included older age with those above 60 years more likely to die (odds ratio [OR]: 1.925; 95% CI: 1.148-3.228; pvalue: 0.009), presence of co-morbidities (OR 1.843; 95% CI: 0.983-3.456; p value: 0.070), development of cytokine release syndrome (CRS) (73 [56.2%] vs 57 [43.8%], p value: <0.001), acute kidney injury (31 [81.6%] vs 7 [18.4%], p value: <0.001), cardiac complications (12 [75%] vs 4 [25%], p value: 0.002), and sepsis (29 [87.9%] vs 4 [12.1%], p value: <0.001). Non-survivors were more likely to develop acute respiratory distress syndrome (ARDS), having been placed on NIV and mechanical ventilation. Laboratory parameters at final outcome found that in non-survivors, median total leukocyte count, C-reactive protein (CRP), neutrophil lymphocyte ratio (NLR), and lactate dehydrogenase (LDH) were higher, while absolute lymphocyte count and platelet counts were lower which were found to be statistically significant compared to survivors. Conclusion: In this study of patients with severe COVID-19 pneumonia at a public sector hospital in Karachi, Pakistan, most were males, and the average age was 60 years. Mortality was high, and associated factors included older age, presence of comorbid conditions, and the development of ARDS, CRS, and sepsis.

show abstract

Section: Discussionmentioning

confidence: 78%

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan

Baqi¹,

Naz²,

Sayeed³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“… 2 Recently a few authors have also reported this in Covid-19 patients. 3 , 4 In this communication we report an occurrence of bilateral subcutaneous emphysema in a patient of COVID-19 pneumonia without pneumothorax and pneumomediastinum having no previous history of respiratory disease.…”

Section: Introductionmentioning

confidence: 80%

Non-invasive ventilation (NIV) induced bilateral subcutaneous emphysema in SARS COV-2 patient: A rare occurrence

Routaray

Prasad

Rajagopalan

2021

Trends in Anaesthesia and Critical Care

View full text Add to dashboard Cite

“…studied eleven non-intubated patients of COVID-19 with spontaneous pneumomediastinum and subcutaneous emphysema. All these patients were non-smokers, among which five were diabetic and four patients expired during their hospital stay [ 14 ]. This is similar to the prognosis and data of our patient.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum and subcutaneous emphysema in a non-intubated COVID-19 patient: a case report

Jatoi¹,

Khan²,

Mohiuddin³

et al. 2021

Pan Afr Med J

View full text Add to dashboard Cite

The development of spontaneous pneumomediastinum and subcutaneous emphysema are few of the rare clinical manifestations observed in coronavirus disease-19 (COVID-19) patients which are yet to be fully understood. Most cases of spontaneous pneumomediastinum arise due to factors causing high intra-alveolar pressure. Herein, we report a case of a COVID-19 positive elderly male, who presented with spontaneous pneumomediastinum and subcutaneous emphysema unrelated to high-pressure ventilatory measures, detected on chest computed tomography (CT). Despite acute medical care, the patient progressed towards a more serious clinical course. Male gender and diffuse alveolar damage caused by COVID-19 seems to be the most relevant association in this case. However, we have enlightened other possible pathological mechanisms and their association with severity index of COVID-19.

show abstract

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Cited by 64 publications

References 37 publications

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan

Non-invasive ventilation (NIV) induced bilateral subcutaneous emphysema in SARS COV-2 patient: A rare occurrence

Spontaneous pneumomediastinum and subcutaneous emphysema in a non-intubated COVID-19 patient: a case report

Contact Info

Product

Resources

About