Abstract
Background: Coronavirus disease 2019 mainly affect the lungs which can complicate into pneumothorax and require hospitalization. We aimed to discuss the presence of pneumothorax and its possible risk factors in vulnerable patients of COVID-19 to establish an effective preventive and therapeutic strategy for this fatal complication.
 Methods: This retrospective observational study included 30 admitted patients of COVID-19 associated pneumothorax. The patient’s data concerning demography, clinical manifestation, associated medical illness, point of onset of pneumothorax, mode of oxygenation with FiO2 and PEEP, radiological imaging, and outcome were extracted from their medical records. All collected data were tabulated, compiled, and analyzed to establish possible causality of pneumothorax.
 Results: All patients of the study group exhibited symptomatic presentations, 73% of patients had severe clinical conditions and 24 patients also had associated chronic medical illness. In our study pneumothorax developed 3rd week onwards after symptoms onset with a mean time of pneumothorax was found to be 23.96 days (23.96±8.06). At the point of diagnosis of pneumothorax, 22 patients were on non-invasive ventilation, 6 on high flow mask, and 2 patients on invasive ventilation, these patients required higher FiO2 (77.66%) and higher PEEP (10.83 cmH2O) to maintain PaO2 within normal range. All patients had raised COVID-related inflammatory markers viz. NLR, D-dimer, CRP, IL-6, and these markers showed a positive correlation with the duration of hospital stay in patients of pneumothorax.
 Conclusion: Pneumothorax can be suspected in COVID-19 infected patients having severe COVID-19 pneumonia of longer duration with assistant ventilation and raised inflammatory markers going to rapid worsening of symptoms.
Highlights
Coronavirus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)
Pneumothorax can be suspected in COVID-19 infected patients having severe COVID-19 pneumonia of longer duration with assistant ventilation and raised inflammatory markers going to rapid worsening of symptoms
We aimed to describe the clinical characteristics of patients with the management protocol and consider whether the development of pneumothorax can be used as a marker of poor prognosis
Summary
Coronavirus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The most common clinical manifestation of COVID-19 positive patients includes fever, cough, and shortness of breath. The complications of COVID-19 include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, disseminated intravascular coagulation, and pneumothorax [1,2]. Common High-resolution computerized tomography (CT) findings in COVID-19 are of patchy ground-glass opacities with a peripheral or posterior distribution, mainly involving the lower lobes [4]. Pneumothorax has been reported in a few patients with COVID-19, the significance and frequency of this association remain unclear. Pneumothorax has been noted in complicated cases of COVID-19 requiring hospital admission and the rate of pneumothorax and pneumomediastinum in ventilated patients has been reported as 15% [6]. We aimed to describe the clinical characteristics of patients with the management protocol and consider whether the development of pneumothorax can be used as a marker of poor prognosis
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