ABSTRACT
An unusual case of a 35-year-old woman with COVID-19 pneumonia who suddenly desaturated while on continuous positive airway pressure leading to pneumomediastinum and surgical emphysema thereby requiring ventilatory support in intensive therapy unit. It is unclear from history and clinical assessment; whether this complication was directly related to COVID-19 pneumonia and it worsened with the initiation of CPAP, OR it was a direct complication of CPAP.
Subject(s)
COVID-19 , Mediastinal Emphysema , Subcutaneous Emphysema , Adult , COVID-19/complications , Continuous Positive Airway Pressure/adverse effects , Female , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Postoperative Complications , Subcutaneous Emphysema/complications , Subcutaneous Emphysema/therapyABSTRACT
Recent publications have suggested an association between coronavirus disease 2019 (COVID-19) pneumonitis and pneumomediastinum. The association has been linked to the frequent use of mechanical ventilation in these patients; however, there have also been increasing reports of spontaneous pneumomediastinum in the absence of mechanical ventilation. These reports suggest a direct association between COVID-19 pneumonitis and increased alveolar fragility. In this report, we present a case of a spontaneous mediastinum in a 64-year-old male patient with COVID-19 without any history of mechanical ventilation.
ABSTRACT
The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.