Pneumomediastinum and pneumothorax in CoViD-19 patients: A case series

ABSTRACT

Background: Pneumomediastinum and pneumothorax are not rarely observed during the CoViD-19 pandemic especially among mechanically ventilated patients. We present a case series of six patients with pneumothorax and pneumomediastinum in CoViD- 19 pneumonia. Presentation of the case series All patients were males with a mean age of 59.63 years. Two patients had spontaneous pneumomediastinum and pneumothorax.One of them denied tobacco or respiratory disease, while the other patient had an history of spontaneous pneumothorax.Four of the six patients received noninvasive ventilation and the average number of days between ventilation and subsequent barotrauma was 8,5 days. Positive end expiratory pressure (PEEP) was started at 10 cmH2 and then reduced to 8 cmH2.Three of patients had not significant comorbidities, while two of them had a medical history significant for hypertension, type 2 diabetes and ischemic heart disease. Five of six patients had a extensive bilateral interstitial pneumonia and no evidence of pulmonary embolism, three of them also had secondary bacterial pneumonia. Pneumomediastinum was treated conservatively in all patients. One patient with extensive pneumothorax required drainage. The probability of pneumomediastinum and pneumothorax increase with the combination of parenchymal injury from CoViD-19 infection and inflammatory response with additional positive pressure ventilation and likely super imposed bacterial infection. Conclusions: Pneumomediastinum and pneumothorax are important CPAP/NIV therapy complications in CoViD-19 and they should be considered if patients begin to deteriorate.