The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

Chong, Woon H.; Saha, Biplab K.; Hu, Kurt; Chopra, Amit

doi:10.1016/j.hrtlng.2021.04.005

Cited by 70 publications

(116 citation statements)

References 64 publications

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“…Although in the present analysis these two complications did not appear to be related to the disease severity, studies on selective cohorts of invasively ventilated patients in ICU reported higher incidences (6.1–15%) [ 4 , 5 , 6 , 8 , 14 , 15 ], while in all hospitalized COVID-19 patients, lower incidences were reported (0.97–2%) [ 4 , 7 , 8 , 9 , 16 ]. Our result (4.5%) ranks in the middle, probably mirroring the heterogeneity composition of our cohort.…”

Section: Discussioncontrasting

confidence: 76%

“…Moreover, in our study, these results have been shown to be independent of age, sex, and the severity of the disease based on the P/F ratio and the need for respiratory support. Many studies reported similar results in both invasively and non-invasively ventilated patients [ 7 , 8 , 10 , 14 ], although not all studies assessed the same outcomes [ 4 , 6 , 7 ]. In particular, Martinelli et al [ 7 ] observed that the occurrence of PNX/PNM worsened the prognosis in older subjects, while we did not observe such age-related differences in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumothorax (PNX) and pneumomediastinum (PNM) have been described as potential complications in some pulmonary infections [ 2 ], including the other two coronaviruses, causing SARS and MERS [ 3 ]. Several case series and studies, some of them included in a recent systematic review [ 4 ], investigated these complications in hospitalized COVID-19 patients, highlighting the occurrence of PNX/PNM also in COVID-19. However, their effective incidence and their influence on disease outcome are still debated [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

Bonato

Fraccaro

Landini

et al. 2021

JCM

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Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

Bonato

Fraccaro

Landini

et al. 2021

JCM

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“…Our findings are supported by previous studies where although the incidence of a pneumothorax was low (0.3%) in admitted COVID-19 patients, this incidence increased up to 23.8% in those requiring MV. In addition to this, the time interval between a pneumothorax diagnosis and admission had been observed to be around 9 to 19.6 days whereas the time between MV initiation and a pneumothorax was noted to be 5.4 days [ 32 , 33 , 34 , 35 ]. Although a COVID-19-related pneumothorax can be a result of COVID-19-induced inflammation and immune dysregulation, our findings suggest an association between the use of invasive mechanical ventilation and a pneumothorax and encourage further studies to be performed to assess this association.…”

Section: Discussionmentioning

confidence: 99%

Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study

et al. 2021

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Backgroundand Objectives: COVID-19 is a novel infectious disease caused by a single-stranded RNA coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to conduct a nationwide multicenter study to determine the characteristics and the clinical prognostic outcome of critically ill COVID-19 patients admitted to intensive care units (ICUs). Materials and Methods: This is a nationwide cohort retrospective study conducted in twenty Saudi hospitals. Results: An analysis of 1470 critically ill COVID-19 patients demonstrated that the majority of patients were male with a mean age of 55.9 ± 15.1 years. Most of our patients presented with a shortness of breath (SOB) (81.3%), followed by a fever (73.7%) and a cough (65.1%). Diabetes and hypertension were the most common comorbidities in the study (52.4% and 46.0%, respectively). Multiple complications were observed substantially more among non-survivors. The length and frequency of mechanical ventilation use were significantly greater (83%) in the non-survivors compared with the survivors (31%). The mean Sequential Organ Failure Assessment (SOFA) score was 6 ± 5. The overall mortality rate of the cohort associated with patients that had diabetes, hypertension and ischemic heart disease was 41.8%. Conclusion: Age; a pre-existing medical history of hypertension, diabetes and ischemic heart disease; smoking cigarettes; a BMI ≥ 29; a long mechanical ventilation and ICU stay; the need of ventilatory support; a high SOFA score; fungal co-infections and extracorporeal membrane oxygenation (ECMO) use were key clinical characteristics that predicted a high mortality in our population.

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“…Other limitations include the inability to obtain the duration of the pneumothorax, length of hospital stay, and outcome at discharge from the hospital. For example, Chong found that the time to pneumothorax diagnosis was approximately 9.0–19.6 days from admission [ 82 ]. However, that study had the same limitation, the inability to determine the date of symptom onset.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax due to COVID-19: Analysis of case reports

Gaytán¹,

Andrade²,

Valenzo³

2021

Respiratory Medicine Case Reports

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Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.

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The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

Cited by 70 publications

References 64 publications

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study

Pneumothorax due to COVID-19: Analysis of case reports

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