Spontaneous Pneumomediastinum: Rare Complication of Tracheomalacia

Lal, Amos; Mishra, Ajay Kumar; Sahu, Kamal Kant; Noreldin, Mohsen

doi:10.1016/j.arbr.2019.09.010

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…SPM unrelated to intubation or positive pressure ventilation has been previously reported in respiratory infections such as pneumocystis pneumonia (PCP), Staphylococcus aureus pneumonia, cytomegalovirus (CMV), influenza bronchiolitis, and even severe acute respiratory syndrome (SARS) [ 12 , 24 , 25 ]. Additional predisposing factors have been observed such as asthma, corticosteroids, respiratory irritants, and other anatomical abnormalities such as tracheomalacia [ [26] , [27] , [28] , [29] ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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Purpose We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.

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Section: Discussionmentioning

confidence: 99%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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“…The decision of offering ECMO as a lifesaving modality needs to be considered after taking in accounts multiple patient and hospital related factors. If other modalities of improving oxygenation and ventilation such as prone positioning, pharmacological paralysis to improve ventilator synchrony and reduced work of breathing should be tried first [9,33,39,42,43]. Fortunately, early ECMO initiation was lifesaving in our patient.…”

Section: Discussionmentioning

confidence: 91%

“…ECMO can be lifesaving for patients with profound and refractory hypoxemia in COVID-19 ARDS. Due to extensive hospital resource utilization, availability of equipment and invasive nature of ECMO; it remains to be used as a salvage therapy for patients in which despite optimal mechanical ventilation strategies, adequate oxygenation or ventilation cannot be achieved [38][39][40]. As per the recent ELSO (extracorporeal life-support organization) guidance paper; PaO2:FiO2 less than 80 mm Hg for more than 6 hours or PaO2:FiO2 less than 50 mm Hg for less than 3 hours should prompt an early ECMO consult [41].…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

Lal

Mishra

Akhtar

et al. 2021

Monaldi Arch Chest Dis

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COVID-19 has involved numerous countries across the globe and the disease burden, susceptible age group; mortality rate has been variable depending on the demographical profile, economic status, and health care infrastructure. In the current clinical environment, COVID-19 is one of the most important clinical differential diagnoses in patients presenting with respiratory symptoms. The optimal mechanical ventilation strategy for these patients has been a constant topic of discussion and very importantly so, since a great majority of these patients require invasive mechanical ventilation and often for an extended period of time. In this report we highlight our experience with a COVID-19 patient who most likely suffered barotrauma either as a result of traumatic endotracheal intubation or primarily due to COVID-19 itself. We also aim to highlight the current literature available to suggest the management strategy for these patients for a favorable outcome. The cases described are diverse in terms of age variance and other comorbidities. According to the literature, certain patients, with COVID-19 disease and spontaneous pneumothorax were noted to be managed conservatively and oxygen supplementation with nasal cannula sufficed. Decision regarding need and escalation to invasive mechanical ventilation should be taken early in the disease to avoid complications such as patient self-inflicted lung injury (P-SILI) and barotrauma sequelae such as pneumothorax and pneumomediastinum Recent systematic review further supports the fact that the use of non-invasive ventilation (NIV) in certain patients with COVID-19 pneumonia may give a false sense of security and clinical stabilization but has no overall benefit to avoid intubation. While invasive mechanical ventilation may be associated with higher rates of barotrauma, this should not mean that intubation and invasive mechanical ventilation should be delayed. This becomes an important consideration when non-intensivists or personnel with less experience provide care for this vulnerable patient population who may rely too heavily on NIV to avoid intubation and mechanical ventilation.

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“…Our case endorses for the fact that any acute worsening in the clinical picture of the patient with rapid oxygen desaturation in a COVID-19 patient should be thoroughly evaluated and possibility of spontaneous pneumothorax, pneumomediastinum, and pneumopericardium should be considered n addition to other common differentials like worsening pneumonia, flash pulmonary edema, and cardiac tamponade. 12 , 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

A rare case of Pneumopericardium secondary to COVID-19

2020

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Coronavirus disease 2019 (COVID-19) has posed an unparalleled challenge to the medical communities and patients worldwide. This is the third coronavirus pandemic of the decade and worst so far in terms of the number of patients affected and related deaths. Although COVID-19 is a systemic illness, the respiratory system is obvious to be involved first, and takes most of the brunt of SARS-CoV-2 infection. Common upper and lower respiratory presentations could be sore throat, consolidation, ground glass opacities, and acute respiratory distress syndrome in severe cases. Pneumothorax, pneumomediastinum are uncommon clinical findings in association with COVID-19. We hereby report a rare case of spontaneous pneumomediastinum with a synchronous pneumopericardium.

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Spontaneous Pneumomediastinum: Rare Complication of Tracheomalacia

Cited by 6 publications

References 9 publications

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

A rare case of Pneumopericardium secondary to COVID-19

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