Pneumothorax in patients with coronavirus disease 2019 pneumonia with invasive mechanical ventilation

Abstract

OBJECTIVES Our goal was to evaluate the prevalence of and risk factors for pneumothorax in patients with invasive mechanical ventilation in the intensive care unit (ICU) diagnosed with coronavirus disease 2019 pneumonia. METHODS The prevalence of pneumothorax was retrospectively reviewed in 107 patients diagnosed with coronavirus disease 2019 pneumonia and treated in an ICU in Turkey between 11 March 2020 and 30 April 2020. RESULTS The patients were aged 19–92 years; 37 (34.6%) were women. Pneumothorax developed in 8 (7.5%) of the intubated patients. Four (50%) of the patients with pneumothorax and 68 (68.7%) of those without it died. In the univariable logistic regression analysis of the presence of comorbid diseases (P = 0.91), positive end-expiratory pressure (P = 0.18), compliance (P = 0.93), peak pressure (P = 0.41) and the Horowitz index (P = 0.13) did not show statistically significant effects in increasing the risk of pneumothorax. CONCLUSIONS There was no significant increase or decrease in the risk of pneumothorax in patients treated with invasive mechanical ventilation after the diagnosis of coronavirus disease 2019-related pneumonia/acute respiratory distress syndrome. However, consideration of the risk of pneumothorax in these individuals may have the potential to improve the prognoses in such settings.

Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

“…Although in the present analysis these two complications did not appear to be related to the disease severity, studies on selective cohorts of invasively ventilated patients in ICU reported higher incidences (6.1–15%) [ 4 , 5 , 6 , 8 , 14 , 15 ], while in all hospitalized COVID-19 patients, lower incidences were reported (0.97–2%) [ 4 , 7 , 8 , 9 , 16 ]. Our result (4.5%) ranks in the middle, probably mirroring the heterogeneity composition of our cohort.…”

Hemopneumothorax as an Unusual and Delayed Complication of Coronavirus Disease 2019 Pneumonia: A Case Report

“…In another series including 40 patients, the median age was 66 years, and 95% of the patients had comorbidities [3]. In contrast, Ozdemir et al [4] reported that the effect of age and comorbidities on PT was not significant in their study conducted in intubated COVID-19 patients. Our case was 31 years old and had no comorbidities before COVID-19 pneumonia.…”

“…In another study conducted by Zantah et al [ 5 ] including 6 cases, 4 patients died. In another case series, the mortality rate was found to be 50% [ 4 ]. In contrast, Hameed et al [ 9 ] reported that in their series including 3 cases, all patients survived.…”

Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis

“… Author Type of study Place of study Study subjects Characteristics Total cases Barotrauma cases Pneumothorax cases Pneumomediastinum cases Subcutaneous emphysema (SE) cases Pneumopericardium Belletti A [ 16 ] et al, 2021 (all IMV) Observational Study Italy Total: N:116; Barotrauma: 28 Age: Barotrauma (B): 62 (57–70) Other (O): 62 (54–69) Sex: B: Male (23/28) O: Male (75/88) Hypertension: B: 8/28 O: 44/88 DM: B: 5/28 O: 14/88 Active Smoker: B:1/28 O: 2/88 Past Smoker: B:2/28 O: 7/88 116 28/116 Time from intubation to barotrauma: 14.0 ± 11.0 22/28 (78.5%) Chest tube: 18/22(81.8%) Conservative: 4/22(18.2%) One chest tube patient additionally required minithoracotomy (4.5%) 13/28 (46.42%) Conservative: 12/13 Surgical repair for TEF: 1/13 – – Elsaaran H [ 17 ] et al, 2021 (critical Admitted COVID) Retrospective cohort Kuwait N: 343; B: 54; O: 289 Age: B: 55.3 (15.0); O: 56.0 (13.3) Sex: Male B: 42/54; O: 243/289 DM: B: 20/54; O: 123/289 HTN: B: 24/54; O:131/289 343 54/343 49/54 8/54 – 2/54 Jones E [ 18 ] et al, 2020 (severe COVID) retrospective cohort UK N: 83; B: 8 Age: B: 54.5(37.8–57.4); O: 57.8 (50.4–65.2) Sex: Male: B: 8/8; O: 53/75 Smoking: B: (2/8); O: 21/28 83 8/83 4/8 7/8 8/8 Kahn MR [ 19 ] et al, 2021 (ICU COVID) retrospective cohort USA ...…”

“…The quality of individual articles was evaluated using the Joanna Briggs Institute (JBI) [ 8 ] critical appraisal for cohort studies, case-control studies, and case series (Supplementary file 1, Tables 1–3 ) [ 1 , 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ].…”