Air Leak Syndrome and Coronavirus Disease 2019 (Covid-19) Pneumonia – A Case Series

Abstract

Background: The COVID 19 pandemic caused by Severe Acute Respiratory Syndrome Corona Virus – 2 has affected millions around the globe. It presents with a multisystem involvement, predominantly affecting the respiratory system. Spontaneous Air leak syndrome which includes subcutaneous emphysema, pneumomediastinum and pneumothorax has been reported as one of the complications of COVID-19 pneumonia. Method: This is a series of 10 cases, which presented with one or more manifestations of air leak syndrome among patients with covid 19 positive admitted in intensive care unit of Meenakshi Mission Hospital and Research Center, Madurai, India. Results: Out of the 365 cases analysed, 10 cases developed either subcutaneous emphysema, pneumomediastinum or pneumothorax. The incidence rate was 2.73% per 1000 population. None of the 10 patients was on invasive mechanical ventilation before developing air leak syndrome. No one had undergone an invasive procedure like central venous cannulation, intubation or bronchoscopy prior to the onset of air leak. Age group of the sample was 38 to 68 years. All the cases had elevated D-Dimer values. Conclusion: present case series shows that air leak syndrome can develop in COVID-19 patients receiving oxygenation through Nin-Invasive Ventilation (NIV) and High flow Nasal Cannula (HFNC). Recommendation: Patients with covid 19 who develop subcutaneous emphysema and pneumomediastinum should be carefully monitored for signs of pneumothorax which can be life threatening in a sick patient with borderline oxygenation. Keywords: COVID-19 pneumonia, subcutaneous emphysema, pneumomediastinum, pneumothorax