Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/etiology , COVID-19/therapy , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/therapy , Pneumothorax/diagnosis , Pneumothorax/therapy , Radiography, Thoracic , Subcutaneous Emphysema/diagnosis , Tomography, X-Ray Computed , Young AdultABSTRACT
Barotrauma is a commonly reported complication in critically ill patients with ARDS caused by different etiologies, it's rate is reported to be around %10. Pneumothorax/pneumomediastinum in COVID-19 patients seem to be more common and have different clinical characteristics. Here we report 9 patients who had pneumothorax and/or pneumomediastinum during their stay in the ICU. Patients who were admitted to ICU between March 2020 and December 2020, were reviewed for presence of pneumothorax, pneumomediastinum and subcutaneous emphysema during their ICU stay. Demographic characteristics, mechanical ventilation settings, documented ventilation parameters, outcomes were studied. A total of 161 patients were admitted to ICU during the study period, 96 were invasively ventilated. Nine patients had developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema during their admission. Five of them were men and median age was 66.6 years. All patients were intubated and mechanically ventilated. All patients were managed conservatively. One patient was discharged from ICU, the others were lost due to other complications related to COVID-19. Upon detection of pneumothorax and/or mediastinum all patients were managed conservatively by limiting their PEEP and maximum inspiratory pressures and were followed by daily chest X-rays (CXR) for detection of any progress. None of the patients showed increase in size of their pneumothorax and/or pneumomediastinum. Hemodynamically instability due to pneumothorax and/or pneumomediastinum was not observed in any of the patients. Tension pneumothorax was not observed in any of the patients. Most common reason for death was sepsis due to secondary bacterial infections. Acute deterioration with rapid oxygen desaturation or palpation of crepitation over thorax and neck in a COVID-19 patient should prompt a search for pneumothorax or pneumomediastinum. Conservative management may be an option as long as the patients are stable.
Subject(s)
COVID-19 , Respiration, Artificial/adverse effects , SARS-CoV-2 , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Hospitalization , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/etiology , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiologyABSTRACT
Severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) has rapidly spread worldwide since December 2019. An acute respiratory distress syndrome develops in a relevant rate of patients, who require hospitalization. Among them, a nonnegligible rate of 9.8% to 15.2% of patients requires tracheal intubation for invasive ventilation. We report the case of a pneumomediastinum and subcutaneous emphysema developing in a COVID-19 patient secondary to postintubation tracheal injury. The management of COVID-19 patients can be challenging due to the risk of disease transmission to caregivers and epidemic spread. We performed a bedside tracheal injury surgical repair, after failure of conservative management, with resolution of pneumomediastinum and subcutaneous emphysema and improvement of the patient's conditions.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/surgery , Pneumonia, Viral/therapy , Subcutaneous Emphysema/surgery , Thoracic Surgical Procedures/methods , Trachea/injuries , Aged , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Neck , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Pneumopericardium/etiology , Pneumothorax/etiology , Subcutaneous Emphysema/etiology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Intermittent Positive-Pressure Ventilation/methods , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/therapy , Middle Aged , Oxygen Inhalation Therapy/methods , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumopericardium/diagnosis , Pneumothorax/diagnosis , Pneumothorax/therapy , Radiography, Thoracic , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe acute respiratory distress syndrome and, more uncommonly, subcutaneous emphysema and pneumomediastinum. We present a case series of 3 patients with COVID-19 infection managed in the Intensive Care Unit and found to have subcutaneous emphysema and pneumomediastinum on chest imaging. CASE REPORT We present a case series of 3 men, ages 36, 47, and 78 years, diagnosed with COVID-19 via RT-PCR, found to have severe acute respiratory distress syndrome, and managed in the Intensive Care Unit. Two patients described in this case series were mechanically ventilated on low positive end-expiratory pressures and developed subcutaneous emphysema and pneumomediastinum on chest imaging, and 1 patient developed subcutaneous emphysema prior to intubation. Each of these patients had a more eventful hospital course and worse outcomes than most COVID-19 infected patients. CONCLUSIONS Subcutaneous emphysema and pneumomediastinum in COVID-19 patients have been rarely reported and is poorly understood. In our institution, we have found the diagnosis of subcutaneous emphysema and pneumomediastinum in COVID-19 patients is associated with unfavorable outcomes and worse prognosis.