COVID-19-Associated Tension Pneumothorax in Mechanically Ventilated Patients: A Case Series

Abstract

Severe acute respiratory syndrome management secondary to coronavirus (SARS-CoV-2) has been overwhelming for healthcare systems. Patients with SARS-CoV-2 infection can present with symptoms ranging from a mild flu-like illness to acute respiratory distress syndrome (ARDS). Patients who develop coronavirus disease 2019 (COVID-19) infection and present with hypoxic respiratory failure requiring mechanical ventilation typically follow ARDS physiology. Many of them develop complications including pneumothorax, pneumomediastinum, and pneumopericardium. In this case series, we present multiple instances where patients with severe COVID-19 infections developed tension pneumothoraces during their hospital course.

Investigating the Association Between Dynamic Driving Pressure and Mortality in COVID-19-Related Acute Respiratory Distress Syndrome: A Joint Modeling Approach Using Real-Time Continuously-Monitored Ventilation Data

“…Tension pneumothorax is a rare, life-threatening ARDS complication resulting in an alveolar rupture potentially due to increased ΔP (31)(32)(33). Tension pneumothorax is a critical target for early identification by dynamic clinical decision support (CDS) tools as it is a potential cause of abrupt decompensation if not intervened upon (32,33).…”

“…Tension pneumothorax is a rare, life-threatening ARDS complication resulting in an alveolar rupture potentially due to increased ΔP (31)(32)(33). Tension pneumothorax is a critical target for early identification by dynamic clinical decision support (CDS) tools as it is a potential cause of abrupt decompensation if not intervened upon (32,33). We observed a 104-fold increase in the hazard of ICU death, which makes sense from the literature where we see a 39% mortality rate for patients with ARDS compared with a 91% mortality rate with for patients with tension pneumothorax (2,32).…”