Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection

Marza, Adina Maria; Petrică, Alina; Lungeanu, Diana; Sutoi, Dumitru; Mocanu, Adelina Geanina; Petrache, Ioan; Mederle, Ovidiu Alexandru

doi:10.2147/ijgm.s347178

Cited by 11 publications

(20 citation statements)

References 37 publications

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“…We developed an independent dataset with the same inclusion/exclusion criteria for external validation. First, authors who published retrospective studies in 2022 were approached, and their data were included [ 10 , 11 , 12 , 13 ]. Second, authors who reported COVID-19-related PNx/PMEx were contacted and encouraged to share data.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

Woo¹,

Kipkorir²,

Marza³

et al. 2022

JCM

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Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (± pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusion: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

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Section: Discussionmentioning

confidence: 99%

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

Woo¹,

Kipkorir²,

Marza³

et al. 2022

JCM

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“…Sin embargo, el barotrauma no es una condición necesaria para que pueda producirse NMMD. De hecho, muchos pacientes con neumonía por SARS-CoV-2 que desarrollaron NMMD no habían requerido de ventilación mecánica previamente a la aparición del NMMD, por lo que en estos el barotrauma no pudo intervenir de ninguna manera en el desarrollo del NMMD (NMMD espontáneo) 12,[14][15][16][30][31][32][33]38,39 .…”

Section: Nmmd Solounclassified

“…En el caso de NMMD en el seno de COVID-19, el síntoma más frecuente es la disnea (93,3% 38 , 90,9% 7 , 62,3% 23 ) o la tos seca (85,7% 23 , 74,2% 7 , 63,3% 38 ), seguido del dolor torácico (43,3% 38 , 21,4% 23 , 19,7% 7 , 11,9% 9 ), lo cual es también comprensible dado que se trata de pacientes con diagnóstico de neumonía por SARS-CoV-2. La disnea marcada, la fiebre elevada, la taquipnea, el tiraje y la desaturación son manifestaciones que se explican más bien por la neumonía por SARS-CoV-2 en sí que por el NMMD asociado.…”

Section: Clínica De Neumomediastinounclassified

“…En el NMMD/ NMTX asociado a COVID-19 es frecuente ver alteraciones en los marcadores inflamatorios (linfopenia, neutrofilia, leucocitosis, ↑proteína C reactiva, ↑ferritina, ↑lactato deshidrogenasa, ↑fibrinógeno, ↑dímero D, ↓transferrina) debido a la propia COVID-19 1,18 , sobre todo si la COVID-19 es grave 18 , puesto que la probabilidad de aparición de NMMD es mayor cuanta más grave sea la COVID-19 21 . Incluso hay algunos estudios en los que alguno de estos marcadores inflamatorios estaba significativamente más alterado si el paciente con neumonía por SARS-CoV-2 había desarrollado NMMD/NMTX frente a si no había desarrollado NMMD ni NMTX 11,23,38 .…”

Section: Analítica De Sangre En El Neumomediastinounclassified

“…En una revisión sistemática en pacientes receptores de VMI, la mortalidad fue mayor, del 61,6% (IC95%: 50,2-73,0%), entre los pacientes con SDRA por COVID-19 que desarrollaron NMMD/NMTX (57% en NMMD y 59,7% [IC95%: 26,2-93,1%] en NMTX), comparado con aquellos pacientes con SDRA no debida a COVID-19 que también desarrollaron NMMD/NMTX, cuya mortalidad fue del 10% 25 , y con aquellos con SDRA por COVID-19 que no desarrollaron NMMD ni NMTX, cuya mortalidad fue del 49,5% (IC95%: 41,1-58,0%) 25 . En aquellos pacientes ingresados por neumonía por SARS-CoV-2 que no habían recibido soporte ventilatorio de ningún tipo (ni invasivo ni no invasivo), la mortalidad fue casi cuatro veces mayor en aquellos que desarrollaron NMMD/NMTX (espontáneo) frente a los que no (OR: 3,758; IC95% OR: 1,443-9,792) 38 . En pacientes con SDRA por COVID-19 receptores de SRNI (GNAF, CPAP, BPAP), la mortalidad también fue mayor en aquellos que desarrollaron después NMMD/ NMTX o NMMD solo frente a aquellos que no (33,9 vs. 10,5%; OR: 4,39; IC95% OR: 2,45-7,85; p < 0,001 para NMMD/NMTX) (36,0 vs. 10,5%; OR: 4,79; IC95% OR: 2,62-8,77; p < 0,001 para NMMD solo) 23 .…”

Section: Impacto Del Neumomediastino Sobre La Mortalidad En La Covid-19unclassified

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El neumomediastino como complicación de la neumonía por SARS-CoV-2

Lorente-González¹,

Terán-Tinedo²,

Zevallos-Villegas³

et al. 2023

RPR

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La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la población general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento del gradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobre unos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo lo cual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía por SARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes con neumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensivos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, el neumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que se resuelve con tratamiento conservador.

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Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

García-Fadul¹

2023

J Intensive Care Med

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Introduction The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. Methods This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. Results A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. Conclusions In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.

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Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection

Cited by 11 publications

References 37 publications

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

El neumomediastino como complicación de la neumonía por SARS-CoV-2

Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

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