ABSTRACT
Coronavirus disease 2019 (COVID-19), caused by the new coronavirus SARS-CoV-2, is an infectious disease that has caused an increase in hospitalizations for pneumonia;the spectrum of clinical presentation is variable. One such presentation, pneumomediastinum (PM), is defined as the presence of air or some other gas in the mediastinum. It is a rare condition, usually benign and self-limited;it has been seen in patients with COVID-19. Although most cases are, as explained above, self-limited and in addition, can be managed conservatively, close monitoring is recommended, as PM can cause life-threatening hemodynamic and respiratory disturbances. We present a case series of 4 patients with SARS-CoV-2 infection, in whom PM was found, and who were admitted to the Regional Hospital of High Specialty of the Yucatan Peninsula during the period of May 2020 through August 2020.
ABSTRACT
Rationale: Pulmonary function abnormalities have been known to last for months or even years in recovered survivors from previous coronavirus pneumonias. However, the long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) is unknown, and comprehensive clinical follow-up data are lacking, particularly in low-medium income countries. Accordingly, the purpose of this study was to describe changes in persistent symptoms and pulmonary function abnormalities at approximately two and four months of follow-up. Methods: We conducted a prospective, observational study in patients recovering from COVID-19. Patients were evaluated in the pulmonary function laboratory at approximately two and fourth months following the onset of COVID-19 symptoms. During the follow-up visits, patients were asked to report all persistent symptoms at the time of testing from a list currently recognized as part of post COVID syndrome. They then underwent a standardized 6-Minute Walk Test (6MWT) and pulmonary function testing, which included spirometry and diffusion capacity for carbon monoxide (DLCO). Patients were excluded if they were unable to complete all pulmonary function tests in the two follow-up visits. Wilcoxon signed-rank test and McNemar's test were used where appropriate to compare anthropometric, pulmonary function, symptoms, and 6MWT variables between follow-up visits. Results: A total of 30 COVID-19 confirmed patients were included for the follow-up evaluation. The median time from the onset of COVID-19 symptoms to follow-up was 54 days (IQR: 47-70 days) for the first visit and 120 days (IQR: 111-135 days) for the second visit. Although symptoms persisted at the second follow-up visit, the majority of persistent symptoms improved compared to the first visit (Table 1). There was also a marked improvement in the median number of symptoms at the second compared to the first follow-up visit (2 vs. 4 symptoms, respectively, p=0.003). There was a significant improvement in forced vital capacity, forced expiratory volume in 1 second, DLCO, and the proportion of patients with a persistent restrictive pattern on spirometry (Table 1). Despite improvements in pulmonary function, there was no significant change in 6-minute walk distance, although there was a significant improvement in end exercise SpO2. Conclusions: A significant proportion of patients in this study showed improvements in persistent symptoms and pulmonary function at 120 days compared to 54 days following the onset of acute COVID-19 symptoms. Characterizing changes in pulmonary function, symptoms, and functional capacity over time will enable clinicians to understand the long-term implications and recovery trajectory of their COVID-19 patients.