The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review

Melhorn, James; Davies, Helen

doi:10.1007/s13665-021-00272-4

Cited by 12 publications

(10 citation statements)

References 40 publications

(45 reference statements)

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“…Subcutaneous emphysema has been documented at rates of between 63.6% and 90.5% in other COVID-19 PTM series with more than 10 patients [ 13 , 16 – 17 ]. This result is in keeping with high reported rates of subcutaneous emphysema in spontaneous non-COVID PTM of up to 100% [ 1 ] and in excess of lower rates of co-occurrence between subcutaneous emphysema and non-COVID-19 pneumothorax of up to 20% [ 25 ]. It would suggest that subcutaneous emphysema is a feature strongly associated with PTM and not specifically to COVID-19 PTM.…”

Section: Discussionsupporting

confidence: 84%

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

et al. 2022

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BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.MethodsA structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.ConclusionsPneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

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Section: Discussionsupporting

confidence: 84%

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

et al. 2022

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“…In general, there is no guidelines on the management of subcutaneous emphysema exist. There are a variety of case-based recommendations in the literature, but no controlled trial has been conducted to date [5]. Various approaches used to manage subcutaneous emphysema include subcutaneous incisions, needles, drains and cervical mediastinotomy [2] and the superiority of each technique is debatable.…”

Section: Discussionmentioning

confidence: 99%

“…Most subcutaneous emphysema is self-limiting and resolves spontaneously without intervention. However, massive or extensive subcutaneous emphysema that extending beyond the trunk into the neck and head should be managed to prevent the complications such as tension phenomenon leading to dysphagia, dysphonia, palpebral closure, compartment syndrome, and intracranial hypertension [5]. It can also be complicated by restriction of full lung expansion and can lead to high airway pressure causing airway compromise, ventilator failure, severe respiratory acidosis, ventilator failure and pacemaker malfunction [2,6].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Emphysema in COVID-19 Managed with Surgical Tracheostomy: A Case Series

Ahmad¹,

Farasyafiqa²,

Halimahtun³

et al. 2022

J Otolaryngol Rhinol

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Background:The coronavirus disease 2019 (COVID-19) is a multi-system infection which predominantly affects the respiratory system. Subcutaneous emphysema with or without pneumomediastinum and pneumothorax been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. Case presentation:We report three cases of COVID-19 pneumonia complicated by subcutaneous emphysema with all cases showed resolution of emphysema with chest tube followed by tracheostomy. Conclusion:Due to growing number of cases that developed coronavirus infection associated with subcutaneous emphysema, this approach can be considered in treating such condition. However, the timing and efficacy of tracheostomy in COVID-19 patient with subcutaneous emphysema still remain elusive and more studies are needed to confirm the role of tracheostomy in managing subcutaneous emphysema.

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“…Rare cases of extensive subcutaneous emphysema have been documented and most commonly occur following pneumothorax, penetrating trauma and rib fractures, barotrauma, or an iatrogenic insult [5,6,8]. More severe cases of this phenomenon are more often secondary to iatrogenicity, whereas mild cases are associated with pneumothoraces [1].…”

Section: Discussionmentioning

confidence: 99%

Self-Inflicted Abdominal Air Insufflation Leading to Diffuse Subcutaneous Emphysema, Pneumoperitoneum, Pneumomediastinum, Pneumopericardium, and Pneumothorax: A Case Report

Corsi¹,

Ali²,

Kumar³

2022

Cureus

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Subcutaneous emphysema is defined by air becoming confined in the soft tissues beneath the skin and it may occur following various surgical procedures and specific penetrating trauma. While treatment is typically conservative and not required in most cases, massive subcutaneous emphysema may cause significant morbidity and sometimes life-threatening complications such as tension pneumomediastinum and respiratory compromise. Notably, no instances of self-inflicted air insufflation into the abdominal cavity have been reported in the literature. This report depicts a case of a self-inflicted air insufflation in a 40-year-old man via penetration of his umbilicus with a manual air compressor leading to widespread subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, pneumopericardium, and pneumothorax. The pathway of possible air movement between body cavities has been theorized, but excluding case reports and anecdotal evidence, treatment of severe subcutaneous emphysema is less clear. This case report intends to record this unique instance of extensive subcutaneous emphysema and to emphasize the necessity for more definitive guidelines in managing these patients.

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The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review

Cited by 12 publications

References 40 publications

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

Subcutaneous Emphysema in COVID-19 Managed with Surgical Tracheostomy: A Case Series

Self-Inflicted Abdominal Air Insufflation Leading to Diffuse Subcutaneous Emphysema, Pneumoperitoneum, Pneumomediastinum, Pneumopericardium, and Pneumothorax: A Case Report

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