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1.
Clin Med (Lond) ; 22(3): 271-275, 2022 05.
Article in English | MEDLINE | ID: covidwho-1856276

ABSTRACT

Pneumomediastinum and pneumothorax are recognised complications encountered in COVID-19 before or during invasive mechanical ventilation (IMV). The clinical course of patients developing pneumomediastinum before IMV is yet to be evaluated.Four-thousand, one-hundred and thirty-one patients hospitalised with COVID-19 over a 12-month period were retrospectively reviewed to evaluate for incidence, clinical characteristics and outcomes. A subgroup analysis was done to identify any clinical traits between survivors and non-survivors. The overall incidence of pneumomediastinum prior to IMV was 0.92% (n=38) and was seen at admission or during non-invasive respiratory support. Thirty-seven per cent had associated pneumothorax most commonly unilateral (right side). The median (interquartile range (IQR)) duration from admission to developing pneumomediastinum was 7 days (3-11) and complete resolution was seen in 53% of patients; median (IQR) duration to resolution was 8 days (4-17). The in-hospital mortality associated with pneumomediastinum in patients with SARS-CoV-2 (PneumoCoV) was 55%. Increasing age (68 ± 12 years vs 56 ± 14 years; p=0.01), higher body mass index (31 ± 5 kg/m2 vs 28 ± 5 kg/m2; p=0.04), lack of resolution of pneumomediastinum (67% vs 24%; p=0.01; odds ratio (OR) 6.5; 95% confidence interval (CI) 1.5-27.5), presence of concurrent pneumothorax (65% vs 14%; p=0.002; OR 11; 95% CI 2.2-53.1) and elevated procalcitonin levels (>0.5 ng/mL; 81% vs 41%; p=0.01; OR 6; 95% CI 1.4-26) were significant features in those who did not survive.The incidence of PneumoCoV, despite being low, is associated with increased mortality. It is a hallmark of moderate to severe disease with multifaceted contributory factors. Both demographic and clinical factors predict survival.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Humans , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , SARS-CoV-2
2.
J Ayub Med Coll Abbottabad ; 34(2): 366-368, 2022.
Article in English | MEDLINE | ID: covidwho-1848220

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/therapy
3.
Tohoku J Exp Med ; 256(2): 127-130, 2022 02.
Article in English | MEDLINE | ID: covidwho-1765585

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sometimes causes severe coronavirus disease 2019 (COVID-19) pneumonia. Here, we report the case of a 35-year-old man with obesity who showed severe respiratory failure from SARS-CoV-2 infection. Immediate high-resolution computed tomography (HRCT) of the chest after endotracheal intubation revealed a significant pneumomediastinum with diffuse ground-glass opacity and consolidation. Ventilator management was difficult with low tidal volume and low positive end expiratory pressure. Therefore, we administered extracorporeal membrane oxygenation (ECMO) to allow lung rest and prevent further progression of the pneumomediastinum and maintain oxygenation. Since implementing ECMO, the patient's oxygenation has stabilized and follow-up HRCT of the chest revealed dramatic improvement of the pneumomediastinum. We gradually tapered off ECMO and employed a pressure-control mode. He was extubated on day 11. To our knowledge, this is the first reported patient who showed complete pneumomediastinum recovery from COVID-19 pneumonia with ECMO.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Mediastinal Emphysema , Adult , Extracorporeal Membrane Oxygenation/methods , Humans , Lung , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , SARS-CoV-2
4.
Interact Cardiovasc Thorac Surg ; 34(2): 236-244, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1447595

ABSTRACT

OBJECTIVES: The incidence of pneumomediastinum (PNMD), its causes of development and its effect on prognosis in the coronavirus disease 2019 (COVID-19) are not clear. METHODS: Between March 2020 and December 2020, 427 patients with real-time reverse transcriptase-polymerase chain reaction-confirmed COVID-19 admitted to the intensive care unit were analysed retrospectively. Using receiver operating characteristic analysis, the area under the curve (AUC) for initial invasive mechanical ventilation (MV) variables such as initial peak inspiratory pressure (PIP), PaO2/FiO2 (P/F ratio), tidal volume, compliance and positive end-expiratory pressure was evaluated regarding PNMD development. RESULTS: The incidence of PNMD was 5.6% (n = 24). PNMD development rate was 2.7% in non-invasive MV and 6.2% in MV [odds ratio (OR) 2.352, 95% confidence interval (CI) 0.541-10.232; P = 0.400]. In the multivariate analysis, the independent risk factors affecting the development of PNMD were PIP (OR 1.238, 95% CI 1.091-1.378; P < 0.001) and P/F ratio (OR 0.982, 95% CI 0.971-0.994; P = 0.004). P/F ratio (AUC 0.815, 95% CI 0.771-0.854), PIP (AUC 0.780, 95% CI 0.734-0.822), compliance (AUC 0.735, 95% CI 0.677-0.774) and positive end-expiratory pressure (AUC 0.718, 95% CI 0.668-0.764) were the best predictors for PNMD development. Regarding the multivariate analysis, independent risk factors affecting mortality were detected as age (OR 1.015, 95% CI 0.999-1.031; P = 0.04), comorbidity (OR 1.940, 95% CI 1.100-3.419; P = 0.02), mode of breathing (OR 48.345, 95% CI 14.666-159.360; P < 0.001), PNMD (OR 5.234, 95% CI 1.379-19.857; P = 0.01), positive end-expiratory pressure (OR 1.305, 95% CI 1.062-1.603; P = 0.01) and tidal volume (OR 0.995, 95% CI 0.992-0.998; P = 0.004). CONCLUSIONS: PNMD development was associated with the initial P/F ratio and PIP. Therefore, it was considered to be related to both the patient and barotrauma. PNMD is a poor prognostic factor for COVID-19.


Subject(s)
COVID-19 , Mediastinal Emphysema , Humans , Incidence , Intensive Care Units , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , 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.
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
7.
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
8.
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
9.
J Investig Med High Impact Case Rep ; 9: 23247096211016228, 2021.
Article in English | MEDLINE | ID: covidwho-1225749

ABSTRACT

Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.


Subject(s)
COVID-19/complications , Influenza, Human/complications , Mediastinal Emphysema/virology , Pneumonia, Viral/complications , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/therapy , Coinfection , Combined Modality Therapy , Drug Therapy, Combination , Humans , Immunization, Passive , Influenza, Human/diagnosis , Influenza, Human/therapy , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Middle Aged , Oxygen Inhalation Therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2
10.
BMJ Case Rep ; 14(3)2021 Mar 23.
Article in English | MEDLINE | ID: covidwho-1148110

ABSTRACT

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.


Subject(s)
COVID-19/therapy , Mediastinal Emphysema/etiology , Noninvasive Ventilation/adverse effects , Positive-Pressure Respiration/adverse effects , Aged, 80 and over , Conservative Treatment , Diagnosis, Differential , Fatal Outcome , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Middle Aged , Radiography , SARS-CoV-2 , Tomography, X-Ray Computed
12.
Monaldi Arch Chest Dis ; 90(4)2020 Sep 29.
Article in English | MEDLINE | ID: covidwho-1060301

ABSTRACT

Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/therapy , Female , Humans , Incidence , Italy , Male , Mediastinal Emphysema/therapy , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
13.
J Cardiothorac Surg ; 15(1): 301, 2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-835855

ABSTRACT

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 Computed
14.
Eur J Cardiothorac Surg ; 58(3): 646-647, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-694782

ABSTRACT

Pneumomediastinum is a rare clinical finding, but one which can be the source of significant concern for clinicians. By presenting 3 such cases, we highlight that pneumomediastinum can complicate the course of a severe coronavirus disease 2019 infection but emphasize that conservative management is the first-line method of treatment, with gradual resorption of the air from the tissues. It is important to be alert to the development of pneumothorax, which will require drainage.


Subject(s)
Conservative Treatment , Coronavirus Infections/complications , Disease Progression , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Pneumonia, Viral/complications , Aged , Anti-Bacterial Agents/therapeutic use , Blood Gas Analysis , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Continuous Positive Airway Pressure/methods , Coronavirus Infections/diagnosis , Follow-Up Studies , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiography, Thoracic/methods , Rare Diseases , Risk Assessment , Sampling Studies , Time Factors , Tomography, X-Ray Computed/methods , Treatment Outcome
15.
Anaesthesia ; 75(8): 1076-1081, 2020 08.
Article in English | MEDLINE | ID: covidwho-197387

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Adult , Aged , COVID-19 , Coronavirus Infections/therapy , Fatal Outcome , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Prospective Studies , Radiography, Thoracic , Respiration, Artificial/methods , SARS-CoV-2 , Tomography, X-Ray Computed , Trachea/injuries
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