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1.
Minerva Respiratory Medicine ; 61(4):204-211, 2022.
Article in English | EMBASE | ID: covidwho-2205203

ABSTRACT

The number of COVID-19 cases only seem to be soaring. As clinicians are making more progress in understanding this new disease, new complications associated with the disease are catching attention. We present five cases of spontaneous pneumothorax in patients with COVID-19. These cases reveal that a pneumothorax can develop at any phase of the disease, and in patients without any contributing history and/or association with mechanical ventilation due to COVID-19. One plausible explanation is bulla formation resulting to pneumothorax. Clinicians treating COVID-19 must be aware of this complication, which could emerge at any stage of the disease, and misinterpreting this dyspnea as progression of ARDS, could prove fatal to the patient. Copyright © 2021 EDIZIONI MINERVA MEDICA.

2.
Cureus Journal of Medical Science ; 14(11), 2022.
Article in English | Web of Science | ID: covidwho-2203292

ABSTRACT

Pneumothorax is a rare complication among mechanically ventilated patients since low tidal volumes are used nowadays instead of traditional high tidal volumes, but the incidence is slightly higher in patients with high positive end-expiratory pressure (PEEP). Herein we describe a case series of nine patients who were on mechanical ventilation due to acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) and developed pneumothorax in due course. A retrospective analysis was done on COVID-19 intubated patients from March 2020 to June 2020 in a community hospital in Central New Jersey, which was one of the early hit states in the United States at the beginning of the pandemic. Outcomes were studied. The demographics of patients like age, gender, and body mass index (BMI);risk factors like smoking, comorbidities especially chronic lung disease, and the treatment they received were compared. We compared the total number of days on the ventilator, the highest PEEP they received, and the ventilator day when pneumothorax developed. All the patients who developed pneumothorax had a chest tube inserted to treat it. The mortality was noted to be 100% indicating that pneumothorax is a life-threatening complication of COVID-19 and COVID-19 by itself is a risk factor for pneumothorax likely due to a change in lung mechanics. There is a need for large-scale studies to confirm that these outcomes are related to COVID-19.

3.
Annals of Clinical and Analytical Medicine ; 13(12):1314-1318, 2022.
Article in English | Web of Science | ID: covidwho-2202448

ABSTRACT

Aim: Secondary spontaneous pneumothorax is caused by underlying lung disease, while barotraumatic pneumothorax results from mechanical ventilation. SARS-CoV2 (COVID-19) is a disease that is transmitted through droplets and affects many organs such as the lungs, brain, kidney, and liver. The lungs are the most affected organ and have the greatest influence on mortality. In SARS-CoV2 infection, progression of consolidations and expansion towards the upper lobes, the development of pleural or pericardial fluid, the development of lymphadenopathy, the presence of bronchiectasis, the development of cavitation, and pneumothorax are poor prognostic factors. In our study, we aimed to compare factors contributing to the development of pneumothorax in 29 patients who developed pneumothorax during the treatment of COVID-19 infection and follow-up.Material and Methods: Age, gender, habits, co-morbid diseases, clinical, radiological, laboratory, treatment, mortality and morbidity results of 29 patients who developed pneumothorax during the treatment and follow-up of COVID-19 infection were evaluated. Patients were divided into two groups as deceased (Group1) and surviving (Group 2) patients. The results of the groups were compared.Results: We found that mean age, lymphocyte elevation, mechanical ventilator applications, length of stay in the intensive care unit, and complication development after thoracostomy were more significant in Group 1 than in Group 2 (p<0.05), whereas gender, pneumothorax localization, blood group, Rh differences, and smoking were not significant (p>0.05).Discussion: Although the number and ratio of the comparison criteria included in the study were in favor of Group 1, certain parameters were statistically significant. However, the development of pneumothorax is an important cause of mortality in SARS-CoV2 patients.

4.
Indian Journal of Respiratory Care ; 11(4):392-395, 2022.
Article in English | Web of Science | ID: covidwho-2201847

ABSTRACT

Spontaneous subcutaneous emphysema, pneumothorax, and pneumomediastinum are rare entities as the initial presentation of coronavirus infection in patients without positive pressure ventilation. This case series presents five cases of COVID-19 pneumonia who presented with alveolar air leak syndrome without prior invasive or noninvasive ventilation and high-flow nasal cannula oxygenation. Two patients presented with surgical emphysema, two with pneumothorax, and one with pneumomediastinum. This series included 30-50-year-old nonsmokers (three males and two females) with no previous history of any comorbidity and smoking who came to the emergency with symptoms such as cough, breathing difficulty, and respiratory distress. The COVID-19 infection was diagnosed by reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. Chest X-ray and computed tomography showed diffuse multifocal ground-glass infiltrates, interlobular septal thickening, and infiltration in all patients. Three patients had subcutaneous emphysema, two had pneumothorax and pneumomediastinum, and one had pneumomediastinum. Three patients later on required invasive mechanical ventilation. Alveolar air leak syndrome including spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema is rarely seen as the initial presentation of coronavirus pneumonia but may develop after positive pressure ventilation.

5.
Egyptian Journal of Chest Diseases and Tuberculosis ; 71(4):542-546, 2022.
Article in English | EMBASE | ID: covidwho-2201696
6.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190727

ABSTRACT

BACKGROUND AND AIM: Air Leak syndromes (ALS), such as pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum, have been observed in adult patients with respiratory failure secondary to severe acute respiratory syndrome coronavirus-2 SARS-CoV-2 pneumonia with an incidence of approximately ~ 1%. Our aim is to describe the incidence of ALS in children with SARS-CoV-2 pneumonia admitted with respiratory failure to the pediatric intensive care unit (PICU) at 2 large Pediatric Children's Hospitals. METHOD(S): IRB exempted retrospective search of electronic medical record data from patients admitted to the PICUs (Wolfson Children's Hospital and UF Health Shands Children's Hospital) with a diagnosis of SARS-CoV-2 pneumonia with respiratory failure from March 1st, 2020, to December 31, 2021. Diagnosis of SARS-CoV-2 was done with real-time reverse transcriptase PCR performed on nasopharyngeal swab. RESULT(S): 104 patients met criteria for inclusion. The age of the patients ranged from 1 month to 18 years old. Twelve patients (11.5%) presented with or developed ALS including pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum. Of the twelve patients with ALS, three required a chest tube, two were placed on extracorporeal membrane oxygenation (ECMO) and three died. CONCLUSION(S): ALS, with an incidence of 11.5%, are not uncommon in patients with SARS-CoV-2 pneumonia and respiratory failure. ALS contribute to morbidity and was associated with a mortality rate of 25%. To understand if SARS-CoV-2 pneumonia has an intrinsic pathobiology that predispose to ALS, we will perform a propensity score matching with a cohort group considering age-severity of illness and intensity of interventions.

7.
Radiology Case Reports ; 18(3):1197-1200, 2023.
Article in English | ScienceDirect | ID: covidwho-2182598

ABSTRACT

A 48-year-old male presented with spontaneous pneumothorax requiring chest tube placement in the setting of COVID-19 infection. CT chest revealed bilateral ground-glass opacities and multiple, large, gas-filled, cavitary lesions in the lungs bilaterally. These imaging findings led to an initial HIV diagnosis with the patient presenting at a CD4+ count of <32 cells/µL. He was found to additionally have infections with Mycobacterium kansasii, cytomegalovirus, Pneumocystis jirovecii, and Candida albicans. After developing worsening hypoxic respiratory failure, he developed additional pneumothoraces bilaterally, requiring repeated chest tube placement. He was treated with antimicrobial therapy for his underlying infections and subsequently started on combined antiretroviral therapy.

8.
Heliyon ; : e12981, 2023.
Article in English | ScienceDirect | ID: covidwho-2179054

ABSTRACT

Objective The goal of this study was to look at the incidence, risk factors, clinical characteristics, and radiological aspects of COVID-19 patients who developed pneumomediastinum and compare these features between those who died and those who survived. Materials and methods This retrospective observational study included COVID-19 patients having pneumomediastinum on CT from May 2020 to May 2021 in a COVID-19 care hospital. 1st wave patients were considered between the period of May 2020 to January 2021 and those in the second wave between February 2021 to May 2021. The clinical details were analyzed by a consultant intensivist and CT scans were read by a team of 6 resident radiologists and 5 experienced radiologists. Demographic data, co-morbidities, clinical parameters, hemodynamic markers, radiological involvement and associated complications were analyzed. Results During the study period, 10,605 COVID-19 patients were admitted to our hospital of which 5689 underwent CT scan. 66 patients were detected to have pneumomediastinum on CT;26 of them in the first wave and 40 in the second wave. Out of 66, 28 patients were admitted to ICU, 9 during the first wave and 18 during the second wave. The overall incidence of developing pneumomediastinum was 1.16%. Incidence in the 1st wave was 1.0% and in the 2nd wave was 1.29%. The overall mortality rate in admitted COVID-19 patients was 12.83% while it was 43.9% in COVID-19 patients who developed pneumomediastinum. Incidence of pneumomediastinum and pneumothorax was high in patients with extensive parenchymal involvement. 59/66 (89%) cases of pneumomediastinum had severe CT score on imaging. Conclusion We conclude that pneumomediastinum is a marker of poor prognosis. Timely diagnosis of interstitial emphysema or pneumomediastinum will aid in planning early protective ventilation strategies and timely intervention of complications.

9.
Clinical Case Reports ; 10(12) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2172747

ABSTRACT

Coronavirus disease 2019 (COVID-19) has become a worldwide outbreak, and it can cause various symptoms and complications. However, pneumothorax secondary to COVID-19 is relatively uncommon. We herein report a 60-year-old man with bilateral refractory pneumothorax with severe COVID-19. In patients with poor general health and who are difficult to undergo surgery for pneumothorax post-COVID-19, internal treatments such as chest drainage, bronchial occlusion, and pleurodesis are essential to relieving refractory pneumothorax. It also indicates that autologous blood patch pleurodesis is a useful method in terms of efficacy and side effects. Copyright © 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

10.
Radiology Case Reports ; 18(3):903-906, 2023.
Article in English | ScienceDirect | ID: covidwho-2165784

ABSTRACT

Pneumothorax was previously considered as a complication of severe coronavirus disease 2019 (COVID-19) pneumonia. However, it is now known that pneumothorax can develop in other cases. Here, we describe the case of a patient who developed tension pneumothorax after release from isolation from COVID-19 pneumonia. The patient was admitted to our hospital with severe COVID-19 pneumonia on the 10th day after onset. Ventilatory management was carried out on the first day of admission;however, the patient was weaned off the next day. The treatment course was uneventful. On the morning of discharge from the hospital, the patient experienced sudden dyspnea. Chest radiography revealed a large left-tension pneumothorax with a mediastinal shift to the right. As this finding required immediate attention, a chest tube was inserted. Chest computed tomography (CT) showed an airspace in the left thoracic cavity and subpleural thin-walled cystic lesions, such as bullae in the left lobe. One month later, chest CT showed resolution of the cystic lesions. The development of pneumothorax in COVID-19 pneumonia should be considered not only in cases of severe illness, but also after release from isolation. Recently, revisions to measures against COVID-19 have been considered worldwide, including shortening of the isolation period and reviewing the identification of all cases. This is an educational report demonstrating that life-threatening pneumothorax may develop after release from isolation due to COVID-19 pneumonia.

11.
COVID-19 Hastalarında Gelişen Pnömotoraks Mortalite Belirteci Olabilir mi? ; 28(4):357-361, 2022.
Article in English | Academic Search Complete | ID: covidwho-2164315

ABSTRACT

Objectives: The purpose of this study is to investigate the effects of pneumothorax (PX), a rare complication of COVID-19, on mortality. Methods: All patients admitted to our hospital with the diagnosis of COVID-19 were screened, and patients who developed PX were included in the study. Patient demographics data, number of days of hospitalization for comorbidities, day and duration of thorax tube insertion, and laboratory findings during hospitalization were recorded by scanning the hospital automation system and patient records. Results: For our study, 7485 patients hospitalized with the diagnosis of COVID-19 were screened in intensive care unit. PX was detected in 32 (0.296%) of the patients. About 59.4% of these patients included in the study were male. DM was the most common comorbid condition at 56.3%. In these patients, the mortality rate was found to be 90.6%. Conclusion: The data obtained indicate that PX, a COVID-19 complication, leads to a serious increase in mortality. We believe that using protective ventilation methods to avoid the development of pneumotarax will help to reduce mortality. Keywords: COVID-19, mortality, pneumothorax (English) [ FROM AUTHOR]

12.
Romanian Journal of Legal Medicine ; 30(2):112-116, 2022.
Article in English | Scopus | ID: covidwho-2163968

ABSTRACT

SARS-CoV-2 pneumonia associated pneumothorax is a rare, but life-threatening complication. SARS-CoV-2 pandemics put us in an unprecedented situation. Severe respiratory distress syndrome associated with acute respiratory failure has forced physicians to apply personalized emergency diagnosis and treatment to increase the survival rate of these patients. We present our observations in cases of pneumothorax associated with COVID-19 pneumonia, treated in the Thoracic Surgery Department of the "Carol Davila” Central Military Emergency University Hospital in Bucharest. © 2022 Romanian Society of Legal Medicine.

13.
Case Reports in Clinical Practice ; 7(3):148-157, 2022.
Article in English | EMBASE | ID: covidwho-2155947

ABSTRACT

Spontaneous pneumomediastinum has been reported in association with COVID-19. Pneumomediastinum could remain elusive until computed tomogra- phy is performed. Hence, we need to be vigilant even though it generally has a benign clinical course. We presented four confirmed COVID-19 cases with typical ground glass opacity on chest radiograph. All four had the computed tomography that re- vealed pneumomediastinum, pneumothorax and subcutaneous emphysema. Only one patient had pneumomediastinum after intubation. Pneumomediastinum is a devastating finding which should be picked up as early as possible and must be excluded in COVID patients whom deteriorate quickly, as adequate time may pass before any viable intervention can be done to expedite the patients' recovery. Copyright © 2022 Tehran University of Medical Sciences.

14.
Thorax ; 77(7):738, 2022.
Article in English | EMBASE | ID: covidwho-2153084
15.
Prague Med Rep ; 123(4): 279-286, 2022.
Article in English | MEDLINE | ID: covidwho-2145508

ABSTRACT

Spontaneous pneumothorax is a serious and life-threatening complication of SARS-CoV-2 pneumonia. It most commonly occurs during the acute phase of the disease in patients with pre-existing lung disease (e.g. emphysema, bronchiectasis, cystic fibrosis, etc.) and in patients who require oxygen supplementation in any form (low-flow oxygen therapy, high-flow non-invasive or mechanical invasive or mechanical invasion). A rare case of a 52-year-old patient with a spontaneous pneumothorax who developed four weeks after PCR SARS-CoV-2 positivity was described. Interestingly, the patient did not have any factors that the literature considered risky for the development of this complication. During the acute phase of the disease, his condition did not require hospitalization. Imaging examinations could not clarify the cause of pneumothorax. With this case report, we want to point out the fact that spontaneous pneumothorax, as a rare and life-threatening complication of COVID-19 infection, may develop during recovery, and it is necessary to think about this complication in the differential diagnosis of dyspnoea.


Subject(s)
COVID-19 , Pneumothorax , Humans , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/etiology , Pneumothorax/therapy , COVID-19/complications , SARS-CoV-2
16.
Int J Gen Med ; 15: 8249-8256, 2022.
Article in English | MEDLINE | ID: covidwho-2141139

ABSTRACT

Background: Previous studies have been conducted to assess pneumothorax. However, few studies were done to assess pneumothorax in COVID-19 patients in the intensive care unit (ICU). Objective: Our aim is to describe and analyze the prevalence, clinical characteristics, risk factors, and outcomes of COVID-19 pneumothorax patients in the intensive care unit. Methods: We performed a retrospective review of the medical records of 418 patients, who tested positive for COVID-19 by polymerase chain reaction test and required ICU admission in King Fahad Hospital of The University from 02/01/2020 to 01/09/2021. A total number of 36 pneumothorax patients were included in the study. Results: Of 418 patients who were followed up in the intensive care unit as COVID-19 cases, 36 patients developed a pneumothorax (8.61%). The mean age of the patients was 55.6 ± 15.06 years, 23 patients were male, and 13 were female. Seventeen patients were obese, and only one patient was an active smoker. Twenty-four patients had at least one comorbidity; hypertension was the most common. Thirty-two patients were intubated, and the duration of intubation was 23.23 ±15.9 days. The time from intubation to pneumothorax development was 8.8 ± 9.3 days. Six patients were on bilevel positive airway pressure ventilation (BIPAP), 2 patients on continuous positive airway pressure ventilation (CPAP), 3 patients on High-Flow Nasal Cannula ventilation (HFNC), 9 patients on pressure-control ventilation (PC), and 16 patients on pressure regulated volume control ventilation (PRVC). Of 36 patients, 26 died, and the mortality rate was 72.2%. Conclusion: Our study showed that risk factors of pneumothorax occurrence in COVID-19 critically ill patients include male patients, hypertension, diabetes mellitus, endotracheal intubation and mechanical ventilation. More efforts should be made to determine the risk factors and assess the outcomes of those patients to develop preventive measures and management guidelines.

17.
Pulmonology ; 2022.
Article in English | ScienceDirect | ID: covidwho-2122758

ABSTRACT

Background The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence;we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. Methods This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. Results We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients;these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). Conclusions C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma;otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. Trial registration this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).

18.
J Family Med Prim Care ; 11(7): 4083-4087, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2119656

ABSTRACT

Bronchopleural fistula (BPF) is an uncommon entity in patients with coronavirus disease 2019 (COVID-19). It may arise due to various causes ranging from the disease itself to complications of treatment. If left untreated, it may increase the morbidity, hospital stay, and adversely affect the outcome. We hereby present a series of cases with a persistent pneumothorax and associated BPF due to varying etiologies. While three of our cases developed a pneumothorax while on non-invasive ventilation, other three were on oxygen therapy. One patient developed a spontaneous pyopneumothorax and septicemia and succumbed to the complications. Another patient on non-invasive ventilation died due to complications of pregnancy. The management of each case varied depending on their clinical presentation.

19.
Surg Clin North Am ; 102(3): 413-427, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2114238

ABSTRACT

Pleural space diseases constitute a wide range of benign and malignant conditions, including pneumothorax, pleural effusion and empyema, chylothorax, pleural-based tumors, and mesothelioma. The focus of this article is the surgical management of the 2 most common pleural disorders seen in modern thoracic surgery practice: spontaneous pneumothorax and empyema.


Subject(s)
Chylothorax , Empyema , Pleural Diseases , Pleural Effusion , Pneumothorax , Chylothorax/etiology , Chylothorax/surgery , Humans , Pleural Diseases/surgery , Pneumothorax/surgery
20.
Cureus ; 14(10): e30233, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2110935

ABSTRACT

Background and aim Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19 and traditional ventilation strategies using ARDSNet protocol, including low tidal volumes, appear to cause barotrauma in COVID-19 patients at a higher rate than non-COVID-19 ARDS patients. The purpose of our study was to determine if COVID-19 patients with ARDS undergoing mechanical ventilation at St. Joseph's Medical Center (SJMC) developed barotrauma at a higher rate than non-COVID-19 ARDS patients. Methods and materials This study was a retrospective chart review of all patients admitted to critical care units at SJMC with COVID-19 infection and requiring mechanical ventilation from March 1, 2020 to September 30, 2020. The sample included adult patients (aged 18 and above) with the International Classification of Diseases (ICD) 10 code for COVID-19 (U07.1) and patients who were placed on mechanical ventilation for longer than 24 hours, from March 1, 2020 to September 30, 2020. Barotrauma was confirmed via radiographic imaging including chest X-ray, CT, or CT angiography (CTA).  Results One hundred and forty COVID-19 patients underwent mechanical ventilation for longer than 24 hours from March 1, 2020 to September 30, 2020 at our facility. Twenty-six COVID-19 patients (18.6%) met our inclusion criteria (development of barotrauma during hospital admission) of which 25 patients (17.9%) underwent mechanical (invasive and/or non-invasive) ventilation prior to the development of barotrauma. Around 80% of the patients were on non-invasive mechanical ventilation prior to intubation and invasive mechanical ventilation. The categorical breakdown of barotrauma was as follows: pneumothorax 65.4%, subcutaneous emphysema 61.5%, pneumomediastinum 34.6%, and pneumoperitoneum 7.7%. None of the included patients had any previous history of documented barotrauma. Prior to the time of barotrauma, 17 patients were on volume control, seven were on pressure control, and one was not on mechanical ventilation. Of the 17 patients on volume control, only one patient was above the ARDSNet guideline of 6-8 mL/kg ideal body weight (IBW). In comparison to ARDS patients at SJMC in 2019, only two out of 28 patients (7.14%) developed barotrauma during mechanical ventilation.  Conclusions Patients with COVID-19 who underwent mechanical ventilation developed barotrauma at a higher rate than traditional non-COVID-19 patients with ARDS.

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