Pneumomediastinum, Pneumothorax, Pneumoperitoneum Reflects Parenchymal Damage or a Consequence of Ventilatory Support in Patients with Severe Covid19

Abstract

Pneumomediastinum is the presence of air in the mediastinum, located around the heart, and structures in the middle of the thorax, while pneumothorax is the presence of air in the pleural space and pneumoperitoneum is nothing more than air in the peritoneum, these spaces in conditions normal does not contain the presence of air, so its existence should alert the clinician to an abnormality, some of the structures present in these compartments may be affected, in this context, these three entities are closely related to open or closed thoracic or abdominal trauma, break of viscera hollow , esophageal perforation , asthmatic patients with severe crisis , or with COPD due to bull rupture , some athletes with extreme efforts such as lifting weights , others as maneuver valsalva , labor etc. Endometriosis and alpha 1 deficiency antitrypsin Or as a consequence of barotrauma due to invasive or non-invasive mechanical ventilation. In patients with severe covid 19 it seems to be a marker of severe pneumonitis since some studies have reported pneumomediastinum in patients who were not receiving mechanical ventilation at the time of diagnosis, in a study multicenter 377 cases half of the patients with Pneumomediastinum. In this study, 377 cases of 58,484 hospitalized patients with Covid-19 were identified, in 53 hospitals in the United Kingdom, reporting an incidence of 0.64% of these 195/377 deaths (57.7%). Pneumomediastinum was associated with high rates of mechanical ventilation 172/377 (45.6%), mechanical ventilation was the most important predictor at the time of diagnosis (p<0.001), along with age (p<0.01) and age. diabetes (p=0.08). (2) Infrequent complications related to Covid-19 have been described, such as pneumopericardium, this is defined as the presence of air in the pericardial space. Generally, the most frequent cause is iatrogenesis due to procedures and open or closed chest trauma, its pathophysiology is closely related to Pneumomediastinum, pneumothorax and subcutaneous emphysema, 3 basic mechanisms are needed, such as: increased pressure between the alveoli and the perivascular interstitial space, loss of integrity of the alveolar wall (alveolar damage and air entry doors, all this entails that the alveolar air leak, dissects the perivascular interstitial space and travels centripetally towards the mediastinum (in the first place) and from here it can continue to other spaces such as the pericardial space, pleural space or subcutaneous tissue, the examination by Excellence for the diagnosis of pneumopericardium and differentiating it from Pneumomediastinum is computed tomography, this also allows confirming other complications such as pneumothorax and subcutaneous emphysema(1) Below we present a retrospective observational study, in which 400 chest CT scans of patients admitted with a diagnosis of severe covid-19 were reviewed and analyzed in a covid-19 sentinel hospital, Coro, Falcón, Venezuela. The objective was to determine the incidence of Pneumomediastinum, pneumothorax and pneumoperitoneum in patients admitted with severe covid-19, evaluate their signs and symptoms, comorbidities, periods of hospital stay, mortality. The investigation is justified since many of the admitted patients came with deteriorating respiratory status, which was generally attributed to lung parenchymal damage, and the diagnosis of these entities could go unnoticed with fatal consequences for the survival of patients.