Pneumomediastinum in Acute Respiratory Distress Syndrome from COVID-19

Abstract

substantial contributions to the conception of the work as well as critical revision for the initial draft and the revised draft. All authors also provided final approval for this manuscript.

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

“…14 Furthermore, pneumomediastinum has been increasingly described in COVID-19 patients who are not mechanically ventilated or have a concurrent pneumothorax diagnosis. 16,[26][27][28][29][30] This radiologic finding was also observed among the observational studies of SARS and case series of influenza A patients who developed pneumothoraces without a concurrent pneumomediastinum diagnosis, regardless of IMV requirement. 22,[31][32][33][34][35] Nevertheless, pneumomediastinum may indicate the presence of severe underlying lung pathology.…”

Radiological–pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for the Sonic hedgehog and Wnt5a pathways?

“…Pneumomediastinum is a rare complication of acute respiratory distress syndrome (ARDS), when air leaks into the mediastinum. An increased pneumomediastinum incidence, of up to 5–13%, was reported during the coronavirus disease 2019 (COVID-19) pandemic [ 1 , 2 ] and even occurred spontaneously without a history of mechanical ventilation [ 3 ], similarly to the previous severe acute respiratory syndrome (SARS)-1 [ 4 ]. Almost half of the 30 consecutive COVID-19 patients who had prolonged invasive mechanical ventilation had full-thickness tracheal lesions and pneumomediastinum [ 5 ].…”

Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

“…On the contrary, among 160 randomly selected invasively ventilated COVID-19 patients without pneumothorax, mortality was 78/ 160 (49 %).We recently published a systematic review on rate of barotrauma among invasively ventilated COVID-19 patients [2]. Our pooled analysis included data from 13 studies and 1814 patients [3][4][5][6][7][8][9][10][11][12][13][14][15] and we found that pooled estimate of pneumothorax rate was 10.7 % (95 % confidence interval [CI] = 6.7 %-14.7 %), while overall rate of barotrauma event was 16.1 % (95 % CI = 11.8 %-20.4 %). In addition, we found an overall mortality rate for COVID-19 patients who developed barotrauma of 61.6 % (95 % CI = 50.2 %-73.0 %), as compared with a mortality of 49.5 % (95 % CI = 41.1 %-58.0 %) for COVID-19 patients who did not develop barotrauma.We are pleased to read that our findings are further reinforced by another study, that confirms that pneumothorax rate among mechanically ventilated COVID-19 patients is between 10 and 15 %.…”

“…We recently published a systematic review on rate of barotrauma among invasively ventilated COVID-19 patients [2]. Our pooled analysis included data from 13 studies and 1814 patients [3][4][5][6][7][8][9][10][11][12][13][14][15] and we found that pooled estimate of pneumothorax rate was 10.7 % (95 % confidence interval [CI] = 6.7 %-14.7 %), while overall rate of barotrauma event was 16.1 % (95 % CI = 11.8 %-20.4 %). In addition, we found an overall mortality rate for COVID-19 patients who developed barotrauma of 61.6 % (95 % CI = 50.2 %-73.0 %), as compared with a mortality of 49.5 % (95 % CI = 41.1 %-58.0 %) for COVID-19 patients who did not develop barotrauma.…”