Abstract
Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
Highlights
Coronavirus disease 2019 (COVID-19) caused by the new coronavirus 2 (SARS-CoV-2) spread in late 2019 in China and subsequently all over the world in 2020, with Italy being the first involved country in Europe at the end of February 2020
A retrospective study reported an overall incidence of PNX/PNM of 0.54% in COVID-19 patients at emergency department admission [9], while an incidence of 6.1–15% has been reported by studies conducted in invasively ventilated patients [5,6,7,8,10]
The aim of our study is to assess among COVID-19 patients hospitalized for acute respiratory failure whether the occurrence of PNX/PNM was associated with a worse outcome in terms of mortality and length of hospitalization
Summary
Coronavirus disease 2019 (COVID-19) caused by the new coronavirus 2 (SARS-CoV-2) spread in late 2019 in China and subsequently all over the world in 2020, with Italy being the first involved country in Europe at the end of February 2020. Several case series and studies, some of them included in a recent systematic review [4], investigated these complications in hospitalized COVID-19 patients, highlighting the occurrence of PNX/PNM in COVID-19. Their effective incidence and their influence on disease outcome are still debated [5,6,7,8]. A retrospective study reported an overall incidence of PNX/PNM of 0.54% in COVID-19 patients at emergency department admission [9], while an incidence of 6.1–15% has been reported by studies conducted in invasively ventilated patients [5,6,7,8,10]. Since the pandemic outbreak in Italy (February 2020), the three pulmonology intermediate care units (IMCU) of Treviso area (Ca’ Foncello Hospital, via Ospedale 1, 31100 Treviso; Montebelluna City Hospital, via Togliatti 1, 31044 Montebelluna; and Vittorio Veneto City Hospital, via Forlanini 1, 31029 Vittorio Veneto), in the North-East of Italy (tot. 887.806 inhabitants), have treated in their intermediate care beds a total of 1213 patients affected by acute respiratory failure secondary to COVID-19
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