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.

Introduction: As the population ages, frailty is becoming more common and understanding how frailty impacts on patient outcomes has become an integral part of clinical care. To date, there is no evidence available on the relationship between frailty and patient outcomes in pleural disease. In this study we explore the relationship between frailty and both malignant and non-malignant pleural disease using the modified frailty index (mFI). Methods and Analysis: Outpatients with pleural disease will be identified from a prospectively collected single-centre UK database and their data and notes retrospectively analysed. An mFI score will be calculated for each patient and the correlation between their frailty index, final diagnosis and mortality analysed. Dissemination: Study findings will be disseminated by publication in an appropriate journal and presentations at Respiratory and/or Geriatric medicine meetings. Key words: Pleural disease; frailty; survival

For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.

Background Frailty can impact on patient care and its assessment may improve patient management and clinical outcomes. Pleural disease is common and associated with increased mortality and symptoms, but prediction of outcomes is limited and there is currently no evidence available on the relationship between frailty and outcomes in these patients. This protocol describes an observational study which sets out to assess whether frailty correlates with survival and morbidity in patients with malignant or non-malignant pleural disease. Methods Participants with a first episode of pleural disease after 1st January 2005 will be identified from the SAIL Databank using ICD-10 read codes. The electronic frailty index (eFI), included within the databank and measured at the time of first diagnosis of pleural disease, will provide stratification of patients by frailty status. Baseline data collection will also include: patient demographics, presence of comorbidities, smoking status, date of death. The eFI will be correlated with clinical outcomes, including survival, index hospitalisation, length of stay, readmissions, total number of hospitalisations. Our primary analysis will be all-cause mortality by eFI, adjusted for age (≤ 64, 65–74, 75–84, and ≥ 85), sex, ethnicity, deprivation score, smoking status, Charlson Comorbidity Index. The secondary analyses will be pleural disease-specific mortality, time to first hospital admission (all-cause and disease-specific), total length of stay, and readmissions. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. Discussion The aim of this study is to collect targeted data from a large dataset of subjects with a wide range of pleural disease and provide first data of size reviewing the link between frailty and pleural disease. The eFI can be a potential tool to guide clinical decision making in pleural disease. Trial registration Retrospectively registered.

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