Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with COVID-19: Three-Year Debriefing across Five Pandemic Waves

Abstract

Spontaneous pneumothorax and pneumomediastinum (SP–SPM) are relatively rare medical conditions that can occur with or independently of COVID-19. We conducted a retrospective analysis of SP–SPM cases presented to the emergency departments (EDs) of two University-affiliated tertiary hospitals from 1 March 2020 to 31 October 2022. A total of 190 patients were identified: 52 were COVID-19 cases, and 138 were non-COVID-19 cases. The primary outcome we were looking for was in-hospital mortality. The secondary outcomes concerned the disease severity assessed by (a) days of hospitalization; (b) required mechanical ventilation (MV); and (c) required intensive care (IC). All were investigated in the context of the five pandemic waves and the patients’ age and comorbidities. The pandemic waves had no significant effect on the outcomes of these patients. Logistic regression found age (OR = 1.043; 95%CI 1.002–1.085), COVID-19 (OR = 6.032; 95%CI 1.757–20.712), number of comorbidities (OR = 1.772; 95%CI 1.046–3.001), and ground-glass opacities over 50% (OR = 5.694; 95%CI 1.169–27.746) as significant risk predictors of in-hospital death while controlling for gender, smoking, the pandemic wave, and the extension of SP–SPM. The model proved good prediction performance (Nagelkerke R-square = 0.524) and would hold the same significant predictors for MV and IC.

Risk Assessment of Venous Thromboembolism among Septic Shock Patients: Single versus Concurrent Insertion of Central Venous Catheters

“…The presence of a CVC was also proven to be the strongest independent predictor for upper extremity deep vein thrombosis (OR, 7.3; 95% CI, 5.8-9.2) [23]. Kuang et al analyzed 1643 critically ill patients and reported an incidence of symptomatic thrombotic complications of the CVCs of 9.5 per 1000 catheters days [4]. Joks et al reported an incidence of 13.5% of CVC-related VTE in hematological patients [5], whereas in oncology patients, VTE's occurrence appears to range around 5% [6].…”

“…In the last few years, a significant group of patients who are admitted to the ICU and require CVC or CV-HDC placement are those with severe manifestations of COVID-19 disease, who experience respiratory failure, septic shock, multiple organ dysfunction [4]. The hypercoagulable state in patients with SARS-CoV-2 infection is a well-known risk factor for arterial and venous thromboembolism [5], especially in those with advanced vascular access devices [6].…”

Risk Factors for Pulmonary Embolism in Individuals Infected with SARS-CoV2—A Single-Centre Retrospective Study

“…It confronted obstacles in effectively controlling transmission and mitigating the consequences of the disease, encompassing issues related to healthcare infrastructure as well as demographic and societal factors [41]. The literature also shows that severe clinical forms had a markedly higher median duration of disease prior to hospitalisation compared with the mild and moderate forms [42].…”