Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax

Abstract

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.

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

“…1 They are also frequently reported in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, which was first reported in Wuhan, Hubei Province, China, in December 2019. [2][3][4][5] The incidence of SP or SPM (SP-SPM) in patients with COVID-19, the respiratory disease caused by SARS-CoV-2, is currently unknown. A large study by Miró et al 6 reported a small number of patients with SP and COVID-19, with an incidence of less than 1‰.…”

The Role of Surgery in Patients with COVID-19-Related Thoracic Complications

“…In our series, hemothorax was related to iatrogenic factors such as chest tube placement, thoracentesis or previous surgery in 11 patients. The remaining two patients underwent spontaneuos hemothorax or, more likely, it was due to mechanical ventilation, as already described in the literature ( 31 ).…”

COVID-19 Survivor Patients Carrying the Rs35705950 Risk Allele in MUC5B Have Higher Plasma Levels of Mucin 5B

“…Additionally, non-survivors had more days of hospital stay, who had a median of 20 days, compared to those survivors, who had a median of 19 days. It has been reported that IMV use in patients with severe ARDS is related to the presentation of complications such as alveolar injury, which prolongs their hospital stay [ 13 ]. Regarding the outcome, the non-survivors had a higher frequency of requirements of IMV (93.0%) compared to survivors (60.9%).…”