Risk factors of pneumothorax and pneumomediastinum in COVID-19: a matched case–control study

Abstract

Background During the novel coronavirus disease-2019 pandemic, a considerable number of pneumothorax (PNX)/pneumomediastinum (PNM) associated with COVID-19 have been reported, and the incidence is higher in critically ill patients. Despite using a protective ventilation strategy, PNX/PNM still occurs in patients on invasive mechanical ventilation (IMV). This matched case–control study aims to identify the risk factors and clinical characteristics of PNX/PNM in COVID-19. Methods This retrospective study enrolled adult patients with COVID-19, admitted to a critical care unit from March 1, 2020, to January 31, 2022. COVID-19 patients with PNX/PNM were compared, in a 1–2 ratio, to COVID-19 patients without PNX/PNM, matched for age, gender, and worst National Institute of Allergy and Infectious Diseases ordinal scale. Conditional logistic regression analysis was performed to assess the risk factors for PNX/PNM in COVID-19. Results 427 patients with COVID-19 were admitted during the period, and 24 patients were diagnosed with PNX/PNM. Body mass index (BMI) was significantly lower in the case group (22.8 kg/m2 and 24.7 kg/m2; P = 0.048). BMI was statistically significant risk factor for PNX/PNM in univariate conditional logistic regression analysis [odds ratio (OR), 0.85; confidence interval (CI), 0.72–0.996; P = 0.044]. For patients on IMV support, univariate conditional logistic regression analysis showed the statistical significance of the duration from symptom onset to intubation (OR, 1.14; CI, 1.006–1.293; P = 0.041). Conclusions Higher BMI tended to show a protective effect against PNX/PNM due to COVID-19 and delayed application of IMV might be a contributive factor for this complication.

Impact of Pneumothorax on Mortality, Morbidity, and Hospital Resource Utilization in COVID-19 Patients: A Propensity Matched Analysis of Nationwide Inpatient Sample Database

“…(24) Similarly, a matched case-control study of 427 patients showed that PTX patients had a lower average BMI (22.4) than non-PTX patients (24.5), which falls under the lower range compared to our population. (25) In contrast, a large study composed of 9800 COVID-19 patients, of which 67 developed PTX, two thirds of the affected patients had a BMI over 25. (26) Due to the con icting evidence, additional research is needed to thoroughly assess the association between COVID-19, PTX, and other comorbidities.…”

Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS: an unusual mechanism for this complication

“…Interestingly, as previously described in spontaneous pneumothorax, a higher BMI seems to be a protective factor in COVID-19-associated pneumothorax. A prolonged time from symptoms onset to intubation has also been associated with an increased risk of pneumothorax [ 6 ] .…”

“…Interestingly, as previously described in spontaneous pneumothorax, a higher BMI seems to be a protective factor in COVID-19-associated pneumothorax. A prolonged time from symptoms onset to intubation has also been associated with an increased risk of pneumothorax [6] . A recent case report described the occurrence of pneumothorax following a severe COVID-19 infection in a previously healthy patient, who was transiently mechanically ventilated.…”