ABSTRACT
Introduction: Pneumothorax was described as complication in COVID-19 patients although clinical risk predictors for its presentation and the potential role in patient's outcome is still unclear. Aim of the study: To assess risk predictors, therapeutic strategies and outcome of ARDS hospitalized COVID-19 patients with pneumothorax. Method(s): We performed a retrospective case-control analysis of 184 patients admitted for severe respiratory failure to our COVID-19 semi-intensive care respiratory unit (SARS-CoV-2 infection confirmed by molecular testing) from october 2020 to march 2021 reporting clinical and radiological features, comorbidities, treatments and outcomes. Result(s): The 8% of sample experienced spontaneous PNX (of which 75% right PNX and 8% bilateral PNX). The mean age of whole sample was 76 years, 53% males, 43% were obese, 50.5% current or former smokers, 52.7% had hypertension, 80% had a history of cognitive impairment, 80% had received non-invasive ventilation before pneumothorax. The mean P/F of pneumothorax group at our unit admission was 168. The 100% of them underwent chest dreinage. Their mortality was 83.1% (p<0.001). Conclusion(s): PNX may be a complication of severe COVID-19 infection associated with a worse prognosis in terms of mortality, consistently with the possible mechanism of hyperinflammatory form associated with critical illness. In our experience high-flow oxygen therapy may be a safer alternative to avoid the potential fatal occurrence of pneumothorax in COVID-19.
ABSTRACT
PNX was described as an uncommon complication in COVID-19 patients but clinical risk predictors and the potential role in patient's outcome are still unclear. We assessed prevalence, risk predictors and mortality of PNX in hospitalized COVID- 19 with severe respiratory failure performing a retrospective observational analysis of 184 patients admitted to our COVID-19 Respiratory Unit in Vercelli from October 2020 to March 2021. We compared patients with and without PNX reporting prevalence, clinical and radiological features, comorbidities, and outcomes. Prevalence of PNX was 8.1% and mortality was >86% (13/15) significantly higher than in patients without PNX (56/169) (P < 0.001). PNX was more likely to occur in patients with a history of cognitive decline (HR: 31.18) who received non-invasive ventilation (NIV) (p < 0.0071) and with low P/F ratio (HR: 0.99, p = 0.004). Blood chemistry in the PNX subgroup compared to patients without PNX showed a significant increase in LDH (420 U/L vs 345 U/L, respectively p = 0.003), ferritin (1111 mg/dl vs 660 mg/dl, respectively p = 0.006) and decreased lymphocytes (HR: 4.440, p = 0.004). PNX may be associated with a worse prognosis in terms of mortality in COVID patients. Possible mechanisms may include the hyperinflammatory status associated with critical illness, the use of NIV, the severity of respiratory failure and cognitive impairment. We suggest, in selected patients showing low P/F ratio, cognitive impairment and metabolic cytokine storm, an early treatment of systemic inflammation in association with high-flow oxygen therapy as a safer alternative to NIV in order to avoid fatalities connected with PNX.