Pneumothorax in Patients with COVID-19 in Tertiary Intensive Care

Objectives: Objective of the study was to examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of coronavirus disease 2019 (COVID-19) and developed pneumothorax and to determine epidemiology and risks of pneumothorax. Methods: The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary intensive care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were evaluated retrospectively. Results: Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients was detected and acute respiratory distress syndrome (ARDS) in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4±4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their symptom onset. Conclusion: We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction. (English) [ FROM AUTHOR] Amaç: Çalışmanın amacı, üçüncü basamak yoğun bakım ünitesinde koronavirüs hastalığı 2019 (COVID-19) tanısı ile yatırılan ve pnömotoraks gelişen hastaların laboratuvar bulgularının klinik özellikleri ve tedavileri ile birlikte incelenmesi, pnömotoraks epidemiyolojisi ve risklerinin belirlenmesidir. Yöntem: Çalışma;1 Nisan 2020 ile 1 Ocak 2021 tarihleri arasında üç adet üçüncü basamak yoğun bakım ünitesinde (her biri 24 yataklı) takip edilen 681 COVID-19 hastasının elektronik kayıtları geriye dönük olarak incelenerek gerçekleştirildi. Hastaların demografik ve klinik özellikleri, laboratuvar bulguları, mekanik ventilatör parametreleri ve akciğer görüntülemeleri geriye dönük olarak değerlendirildi. Bulgular: COVID-19 geçiren 681 hastanın 22'sinde (%3,2) pnömotoraks ve 481'inde (%70,6) akut respiratuar distres sendromu (ARDS) tespit edildi. Tüm çalışma hastaları ARDS tanı kriterlerini karşıladı. Mortalite oranları tüm hastalarda %43.4 (296/681), ARDS'li hastalarda %52.8 (254/481), pnömotorakslı hastalarda ise %86,3 (19/22) idi. Hastalarda ortalama 17,4±4,8 gün içinde pnömotoraks gelişti. Semptomların başladığı 1. haftada hastaların bilgisayarlı tomografilerinde yaygın buzlu cam opasiteleri, yama infiltratları ile heterojenik dağılım, alveolar eksüdalar, interstisyel kalınlaşma gözlendi. Sonuç: ARDS'li COVID-19 hastalarında pnömotoraksın mortaliteyi önemli ölçüde artırdığını gözlemledik. Pnömotoraksın özelliklerinin anlaşılmasının ve önlenmesinin mortalitenin azaltılmasına önemli katkı sağlayacağına inanıyoruz. (Turkish) [ FROM AUTHOR] Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 and eosinophilic granulomatosis with polyangiitis or COVID-19 mimicking eosinophilic granulomatosis with polyangiitis?

Coronavirus disease 2019 (COVID-19) and eosinophilic granulomatosis with polyangiitis (EGPA) share similarities in clinical, imaging findings and may present with respiratory distress. Differentiating a new-onset EGPA from COVID-19 during the current pandemic is a diagnostic challenge, particularly if other EGPA symptoms are overlooked. Here in this study we reviewed the literature regarding EGPA patients with COVID-19 and patients who diagnosed with EGPA or suffered an EGPA flare mimicking COVID-19. We conducted a literature survey in PUBMED database using meshed keywords "COVID-19" and "EGPA", "COVID-19" and "eosinophilic granulomatosis with polyangiitis", "COVID-19" and "Churg Strauss Syndrome", to reveal previously reported cases involving EGPA patients who had COVID-19 infection, patients who suspected to have COVID-19 but eventually diagnosed with EGPA and patients with a known diagnosis of EGPA who suffered a flare but a COVID-19 infection was suspected initially. A total of 11 cases (6 literature cases, 5 cases from our clinic) were included in our study. Seven (63.6%) of the cases were defined as COVID-19 mimicker and 4 (36.4%) were EGPA with COVID-19. All of the cases in EGPA with COVID-19 group had a history of asthma. All of them had a positive PCR result and ground-glass opacities in thorax CT. In COVID-19 mimicker group, six (85.7%) patients had a history of asthma and other EGPA features that were observed were eosinophilia in 6 (85.7%). Our study provided clues regarding the EGPA/COVID-19 diagnostic challenge which may be useful in the current pandemic. Since none of the findings in COVID-19 are disease-specific, other conditions like EGPA should not be overlooked particularly in PCR negative patients and clinical, laboratory and imaging findings should be interpreted carefully. Furthermore, we did not observe poor outcomes in EGPA patients who had COVID-19.