Cervico-Thoracic Air Collections in COVID-19 Pneumonia Patients - Our Experience and Brief Review.

Introduction: Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections (pneumothorax, pneumomediastinum, and subcutaneous emphysema). Material and Methods: We conducted an 8-months retrospective analysis of a single-center SARS-CoV-2 cases associating pneumothorax, pneumomediastinum, and subcutaneous emphysema, either alone or combined. Results: All non-intubated patients with the complications cited above had a favorable outcome after pleural drainage, percutaneous drainage, and/or conservative treatment, while the intubated patients, with multiple comorbidities, have had an unfavorable outcome, regardless the chosen treatment. Pleural drainage was used for pneumothorax cases; pneumomediastinum with subcutaneous emphysema required insertion of subcutaneous needles or angio-catheters with manual decompressive massage. Conservative methods of treatment were used for patients with pneumomediastinum and medium or severe respiratory disfunction. Conclusions: Etiopathogenic classification of pneumothorax should include SARS-CoV-2 infection as a possible cause of secondary spontaneous pneumothorax due to COVID-19 pneumonia. Survival rate after the occurrence of these complications was small (18,75%), 4 of the patients were cured, 2 had a favorable outcome and 26 have died. Pleural drainage which is mandatory to do for patients with pneumothorax complication in COVID -19 pneumonia, doesn't change the prognosis for those with severe affecting lungs, because the prolonged ventilation and the other comorbidities have led to death in most of these cases.

Case Of Pneumomediastinum And Surgical Emphysema In A Patient With Covid-19 Pneumonia, On Cpap.

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.

Negative pressure therapy as a safe alternative in the treatment of massive subcutaneous emphysema in critically ill patients COVID-19.

Many surgical treatments have been described for massive subcutaneous emphysema (MSE) over the recent years. However, there is no consensus on which is the most recommended and there is great diversity in treatment. With new advances in minimally invasive therapy performed at the bedside, especially in intensive care units, it has been possible to increase therapeutic efficacy. During the COVID-19 pandemic, some therapeutic techniques have been discussed in critically ill patients with SARS-COV-2 respiratory infections, because of the potential overexposure of healthcare personnel to an increased risk of contagion after direct exposure to air trapped in the subcutaneous tissue of infected patients. We present the clinical case of an 82-year-old male patient, SARS COV-2 infected, with MSE after 48 h with invasive mechanical ventilation in critical intensive care. He was treated with negative pressure therapy (NPT) allowing effective resolution of the MSE in a short period (5 days) with a minimally invasive bedside approach, reducing the potential air exposure of health personnel by keeping the viral load retained by the emphysema. Therefore, we present NPT as an effective, minimally invasive and safe therapeutic alternative to be considered in the management of MSE in critically ill patients infected with SARS COV-2.

[SARS-CoV-2-associated pneumothorax, pneumomediastinum and soft tissue emphysema. Clinical implications based on a case series]. / SARS-CoV-2-assoziierter Pneumothorax, Pneumomediastinum und Weichteilemphysem. Klinische Implikationen anhand einer Fallserie.

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.

Pneumomediastinum and subcutaneous emphysema after noninvasive ventilation in a COVID-19 patient.

Pneumomediastinum is an uncommon but well recognized complication of both invasive and non-invasive mechanical ventilation. Spontaneous pneumomediastinum has been observed in association with a variety of structural lung diseases including severe interstitial disorders. More recently it has been reported complicating the course of COVID-19 pneumonia. In the present report we describe a case of pneumomediastinum associated with subcutaneous emphysema in a patient with severe respiratory failure due to extensive interstitial pneumoniae correlated to SARS-CoV-2 infection which necessitated non-invasive ventilatory support. Prompt recognition is required during ventilatory support as it may promote its progression. Further data are needed in order to identify the mechanisms, frequency, risk factors and prognostic role of this rare complication of the clinical course of COVID-19.