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2.
J Coll Physicians Surg Pak ; 32(2): 230-232, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1675597

ABSTRACT

Spontaneous pneumomediastinum with COVID pneumonia is a rare occurrence with or without accompanying subcutaneous emphysema or pneumothorax. The aim of this study was to establish relation of this complication to severity of lung disease and its clinical outcome. The study was conducted for a period of seven months from April to October 2020 in the CT Department of Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan. All COVID positive patients having spontaneous pneumomediastinum on high resolution CT (HRCT) chest were included (n=14). These patients were assessed for severity of lung disease as per CT severity score (CTSS), and were followed up for their clinical outcome. All patients with spontaneous pneumomediastinum had moderate to severe degree of COVID pneumonia; mortality in patients with pneumomediastinum was 50%; and was seen in those patients who had greater severity of lung disease as per the CTSS. Key Words: Spontaneous, Pneumomediastinum, COVID, Pneumothorax, Subcutaneous, Emphysema.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology
4.
Crit Care Med ; 50(3): 491-500, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1462522

ABSTRACT

OBJECTIVE: There are concerns of a high barotrauma rate in coronavirus disease 2019 patients with acute respiratory distress syndrome receiving invasive mechanical ventilation. However, a few studies were published, and reported rates were highly variable. We performed a systematic literature review to identify rates of barotrauma, pneumothorax, and pneumomediastinum in coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation. DATA SOURCE: PubMed and Scopus were searched for studies reporting barotrauma event rate in adult coronavirus disease 2019 patients receiving invasive mechanical ventilation. STUDY SELECTION: We included all studies investigating adult patients with coronavirus disease 2019 acute respiratory distress syndrome requiring mechanical ventilation. Case reports, studies performed outside ICU setting, and pediatric studies were excluded. Two investigators independently screened and selected studies for inclusion. DATA EXTRACTION: Two investigators abstracted data on study characteristics, rate of pneumothorax, pneumomediastinum and overall barotrauma events, and mortality. When available, data from noncoronavirus disease 2019 acute respiratory distress syndrome patients were also collected. Pooled estimates for barotrauma, pneumothorax, and pneumomediastinum were calculated. DATA SYNTHESIS: A total of 13 studies with 1,814 invasively ventilated coronavirus disease 2019 patients and 493 noncoronavirus disease 2019 patients were included. A total of 266/1,814 patients (14.7%) had at least one barotrauma event (pooled estimates, 16.1% [95% CI, 11.8-20.4%]). Pneumothorax occurred in 132/1,435 patients (pooled estimates, 10.7%; 95% CI, 6.7-14.7%), whereas pneumomediastinum occurred in 162/1,432 patients (pooled estimates, 11.2%; 95% CI, 8.0-14.3%). Mortality in coronavirus disease 2019 patients who developed barotrauma was 111/198 patients (pooled estimates, 61.6%; 95% CI, 50.2-73.0%). In noncoronavirus disease 2019 acute respiratory distress syndrome patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, -2.1% to 13.5%). CONCLUSIONS: Barotrauma occurs in one out of six coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation and is associated with a mortality rate of about 60%. Barotrauma rate may be higher than noncoronavirus disease 2019 controls.


Subject(s)
Barotrauma/etiology , COVID-19/therapy , Mediastinal Emphysema/etiology , Pneumothorax/etiology , Respiration, Artificial/adverse effects , Barotrauma/mortality , COVID-19/mortality , Humans , Mediastinal Emphysema/mortality , Pneumothorax/mortality , SARS-CoV-2
5.
Eur J Med Res ; 26(1): 114, 2021 Sep 26.
Article in English | MEDLINE | ID: covidwho-1440956

ABSTRACT

BACKGROUND: Pneumomediastinum is a rare complication of COVID-19 pneumonia, which may or may not be associated with invasive ventilatory support. Therefore, the report and findings associated with its evolution can be of great contribution in the management of this unknown disease. CASE PRESENTATION: Here, we present a series of four patients with severe pneumomediastinum requiring intensive care unit. These patients developed pneumomediastinum before or during orotracheal intubation (OTI) or without OTI. The four patients were three men and one woman with a mean age of 60.5 years (48-74 years). No patients had a known history of lung disease or traumatic events, except for one patient who had a history of smoking, but who was without parenchymal disease. All intubations were performed without complications. No cases of pneumomediastinum occurred after tracheostomy, and none of the patients had tomographic or bronchoscopic evidence of tracheal injury. Although the pneumomediastinum observed in our cases was apparently not related to a violation of the aerodigestive track, this complication was associated with a worse prognosis. CONCLUSION: Pneumomediastinum is a rare complication of COVID-19 pneumonia, and the most likely etiopathogenesis is severe pulmonary involvement, which may or may not be associated with invasive ventilatory support. Future studies with a greater number of cases should elucidate the relationship of pneumomediastinum to a probable prognostic factor.


Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19/therapy , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Middle Aged , Respiration, Artificial , Tomography, X-Ray Computed
6.
J Intensive Care Med ; 37(1): 12-20, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1405276

ABSTRACT

Background: Since the beginning of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, pneumomediastinum has been reported in patients with COVID-19 pneumonia and acute respiratory distress syndrome. It has been suggested that pneumomediastinum may portend a worse outcome in such patients although no investigation has established this association definitively. Research Question: We hypothesized that the finding of pneumomediastinum in the setting of COVID-19 disease may be associated with a worse clinical outcome. The purpose of this study was to determine if the presence of pneumomediastinum was predictive of increased mortality in patients with COVID-19. Study Design and Methods: A retrospective case-control study utilizing clinical data and imaging for COVID-19 patients seen at our institution from 3/7/2020 to 5/20/2020 was performed. 87 COVID-19 positive patients with pneumomediastinum were compared to 87 COVID-19 positive patients without pneumomediastinum and to a historical group of patients with pneumomediastinum during the same time frame in 2019. Results: The incidence of pneumomediastinum was increased more than 6-fold during the COVID-19 pandemic compared to 2019 (P = <.001). 1.5% of all COVID-19 patients and 11% of mechanically ventilated COVID-19 patients at our institution developed pneumomediastinum. Patients who developed pneumomediastinum had a significantly higher PEEP and lower P/F ratio than those who did not (P = .002 and .033, respectively). Pneumomediastinum was not found to be associated with increased mortality (P = .16, confidence interval [CI]: 0.89-2.09, 1.37). The presence of concurrent pneumothorax at the time of pneumomediastinum diagnosis was associated with increased mortality (P = .013 CI: 1.15-3.17, 1.91). Conclusion: Pneumomediastinum is not independently associated with a worse clinical prognosis in COVID-19 positive patients. The presence of concurrent pneumothorax was associated with increased mortality.


Subject(s)
COVID-19 , Mediastinal Emphysema , Case-Control Studies , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2
7.
Medicina (Kaunas) ; 57(9)2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1390694

ABSTRACT

Lung failure has been the most common cause of hospitalization for COVID-19. Yet, bilateral interstitial pneumonia has not been the only cause of lung failure of these inpatients, and frequently they develop other illnesses associated with COVID-19. Pulmonary embolism has been the most looked for in the world, but rarely other pneumological diseases, such as pneumothorax and pneumomediastinum, have been described and associated with a worsening prognosis. We here report our clinical experience associated with the occurrence of pneumothorax and pneumomediastinum in a cohort of inpatients hospitalized in our division of medicine in a regular ward or in a sub-intensive ward.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Critical Care , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Pneumothorax/etiology , SARS-CoV-2
9.
Wien Med Wochenschr ; 172(3-4): 84-89, 2022 Mar.
Article in German | MEDLINE | ID: covidwho-1353705

ABSTRACT

The new coronavirus (SARS-CoV-2) that arose in 2019 causes a wide spectrum of symptoms and different courses of disease. Pneumothorax, pneumomediastinum and soft tissue emphysema are rare complications in patients with pulmonary involvement. They are the sequelae of severe, virus-induced structural changes of the pulmonary architecture. High pressure artificial ventilation aggravates the problem. Hence pneumothorax and ectopic air in soft tissues are indicators of extensive pulmonary damage. Therefore, efforts should be made to treat even very small or multiply recurrent pneumothorax by drainage procedures.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , COVID-19/complications , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/therapy
11.
Asian Cardiovasc Thorac Ann ; 30(2): 237-244, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1305542

ABSTRACT

INTRODUCTION: There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes. METHODS: The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium). RESULTS: A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006). CONCLUSION: Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Middle Aged , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2 , Treatment Outcome
14.
Eur Rev Med Pharmacol Sci ; 25(12): 4413-4417, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1296352

ABSTRACT

We report a case of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, occurring in an adolescent resulting positive to SARS-CoV-2 nasopharyngeal swab. At the admission in Emergency Department, the child presented with left cervical and sternal pain, without respiratory symptoms. Radiological studies showed sizeable pneumomediastinum, bilateral apical pneumothorax, massive emphysema subcutaneous and pneumorrhachis. Patients' clinical conditions stood stable during the monitoring and he only needed conservative management. To our knowledge, this is the first description of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, in a COVID-19 adolescent without concomitant pneumonia.


Subject(s)
COVID-19/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Pneumorrhachis/diagnostic imaging , Pneumothorax/diagnostic imaging , Adolescent , COVID-19/complications , Humans , Male , Mediastinal Emphysema/etiology , Pneumorrhachis/etiology , Pneumothorax/etiology
15.
Gac. méd. Méx ; 157(1): 116-120, ene.-feb. 2021. tab, graf
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1285653

ABSTRACT

Resumen El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.


Abstract Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.


Subject(s)
Humans , Male , Adult , Middle Aged , Aged, 80 and over , Subcutaneous Emphysema/etiology , COVID-19/complications , Mediastinal Emphysema/etiology
16.
Minerva Med ; 112(6): 779-785, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1278855

ABSTRACT

BACKGROUND: Pneumomediastinum (PNM) can develop as a severe complication of severe COVID-19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation. METHODS: Our aim was to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series. RESULTS: Twenty-one patients were diagnosed, four were treated with high-flow nasal cannula, thirteen with non invasive ventilation and four with invasive mechanical ventilation. In five cases PNM was massive and associated to subcutaneous emphysema; more rarely PNM was associated with pneumothorax. Conservative management was the most used therapeutic strategy. CONCLUSIONS: PNM is a serious and not extremely rare complication of severe forms of pulmonary involvement of COVID-19. The clinician should consider this rare complication; moreover, we suggest being careful when clinicians start mechanical ventilation.


Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Pneumonia/etiology , Adult , Female , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/therapy , Middle Aged , Pneumonia/complications , Retrospective Studies , Severity of Illness Index , Young Adult
18.
Gac Med Mex ; 157(1): 110-114, 2021.
Article in English | MEDLINE | ID: covidwho-1268461

ABSTRACT

Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.


El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.


Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Subcutaneous Emphysema/etiology , Adult , Aged, 80 and over , Humans , Male , Middle Aged
19.
Epidemiol Infect ; 149: e137, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1260912

ABSTRACT

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.


Subject(s)
COVID-19/complications , Hemothorax/etiology , Mediastinal Emphysema/etiology , Pneumothorax/etiology , Respiratory Distress Syndrome/complications , Subcutaneous Emphysema/etiology , Adult , Aged , Barotrauma/epidemiology , Barotrauma/etiology , COVID-19/epidemiology , COVID-19/therapy , Female , Hemothorax/epidemiology , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Lung Injury/epidemiology , Lung Injury/etiology , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/epidemiology , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Subcutaneous Emphysema/epidemiology
20.
Respir Investig ; 59(5): 661-665, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1253540

ABSTRACT

In this study, we compared the incidence of pneumomediastinum in coronavirus disease (COVID-19) patients during the ascending phases of the 1st and 2nd epidemic waves. Crude incidence was higher during the 2nd wave at a quasi-significant level (0.68/1000 vs. 2.05/1000 patient-days, p = 0.05). When restricting the analysis to patients who developed pneumomediastinum during noninvasive ventilation, the difference became clearly significant (0.17/1000 vs 1.36/1000 patient-days, p = 0.039). At logistic regression, predisposing factors (p = 0.031), and COVID-19 radiological severity (p = 0.019) were independently associated with pneumomediastinum. Mortality in patients with pneumomediastinum was 87.5%. However, pneumomediastinum seemed to be related to a generally worse disease presentation in hospitalized patients during the 2nd wave, rather than to a separate pattern of disease.


Subject(s)
COVID-19 , Mediastinal Emphysema , COVID-19/complications , Humans , Incidence , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pneumothorax , SARS-CoV-2
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