Recurrent Pneumothorax in an Adult Male With Bilateral COVID-19 Pneumonia.

Ayusha Poudel,Ishu Shrestha,Barun B Aryal,Anurag Adhikari,Yashasa Poudel

doi:10.7759/cureus.17025

Abstract

Pneumothorax is defined as the condition in which air is collected between the visceral and parietal pleura. Pneumothorax as a complication of coronavirus disease 2019 (COVID-19) infection has been reported in relatively few cases and recurrent pneumothorax is even rarer. We present a case of a 50-year-old critically ill patient who required mechanical ventilation for 55 days and developed recurrent bilateral pneumothorax. The patient initially presented with shortness of breath and cough. He was found to be COVID-19 positive on the polymerase chain reaction (PCR) test. Subsequently, his oxygen demand increased, and he ultimately needed mechanical ventilation. He developed four episodes of pneumothorax. The patient was managed in all four episodes with intercostal tube insertion. To prevent subsequent episodes, pleurodesis was performed after the fourth episode of pneumothorax.

Highlights

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) has a multitude of pulmonary and extra-pulmonary manifestations [1]
We present a case of a 50-year-old male with recurrent spontaneous pneumothorax placed on mechanical ventilation for 55 days
The patient was intubated an hour later with the ventilator settings in assist control/volume control (AC/VC) mode with the respiratory rate (RR) of 15 breaths/min, tidal volume (Vt) of 350 milliliters, partial endexpiratory pressure (PEEP) of 7 centimeter of water, and fraction of inspired oxygen (FiO2) of 100%. His peripheral oxygen saturation did not rise above 84% and the RR was recalibrated to 18 breaths/min, Vt to 360 mL, and PEEP to 9 cm H2O

Summary

Introduction

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) has a multitude of pulmonary and extra-pulmonary manifestations [1]. On the 16th day of admission, he developed a fever of 100.4°F and his ABG reports showed a pH of 7.3, PaO2 of 86 mmHg, PaCO2 of 61 mmHg and bicarbonate of 31.6 mEq/L with a ventilator setting in AC/VC mode RR of 26/min, Vt of 280 mL and PEEP 10 cm H2O and FiO2 55%. The right-sided intercostal tube was removed on the 20th day of insertion on the basis of radiological confirmation of resolution of pneumothorax after clamping the chest drain for three hours. On the sixth day following extubation, he developed a left-sided spontaneous pneumothorax (Figure 3) while on 2L/min oxygen via nasal prongs.

Discussion

Conclusions

Findings

Disclosures

Parasher A