Understanding Pneumomediastinum as a Complication in Patients With COVID-19: A Case Series

Abstract

Pneumomediastinum is a rare complication among non-coronavirus patients but has been published with increased incidence in patients positive for SARS-CoV-2 infection. Most of these studies report patients on mechanical ventilation and an understanding of mechanisms causing this remains limited. We aim to use an increasing occurrence in patients not on mechanical ventilation to further explore mechanisms that predispose patients to pneumomediastinum and to assess characteristics potentially related to poor outcomes. We report a case series of 37 patients diagnosed with COVID-19 and pneumomediastinum at a 2-hospital institution between January 1, 2020 and April 30, 2021. At 28 days after diagnosis of pneumomediastinum, 19 (51.4%) were dead and mortality was significantly higher among those who were older ( t = 2.147, P = .039), female (χ2 = 10.431, P = .015), body mass index ≥30 (χ2 = 6.0598, P = .01), intubated (χ2 = 4.937, P = .026), and had pre-existing lung disease (χ2 = 4.081, P = .043). Twenty-three patients (62.2%) were identified to have pneumomediastinum without receiving invasive mechanical ventilation, of which 11 (47.8%) were diagnosed without receiving noninvasive ventilation. The increased diagnosis of pneumomediastinum in patients with COVID-19 while not on mechanical ventilation, in this case series and in comparable studies, may attribute to mechanisms aside from positive pressure ventilation such as patient self-induced lung injury and pulmonary frailty.

COVID-19-Related Pleural Diseases

“…36 Other case series reported around 2 weeks between symptom onset and PTM diagnosis. 47 59 This is consistent with the previous SARS-CoV pandemic of 2002 to 2004 when time from symptom onset to diagnosis was 19.6 ± 4.6 days. 43 Diagnosis of PTM may have been delayed previously as CT-chest usage was less widespread two decades ago.…”

“…Other case series found similar mortality rate 14 30 with significantly higher mortality in females, elderly, obese, and intubated patients with underlying lung disease. 59 The patients with PTM and severe COVID-19 required longer stay in critical care. 25 In previous pandemic of SARS-CoV 2002 to 2004, the mortality of patients with concomitant PTM was estimated at 30.8%.…”