Air Leak Syndrome in Critically Ill COVID-19 Cases

ABSTRACT

Aim and background: Air leak syndrome consists of pneumomediastinum, subcutaneous emphysema, or pneumothorax is rarely seen in viral pneumonia. The reported incidence of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) is 16.7/100,000 for men and 5.8/100,000 for women, with corresponding mortality rates of 1.26/million and 0.62/million per annum, respectively. The development of air leak syndrome has a significant impact on the outcome of COVID-19 management, increasing morbidity and mortality. In this study, we tried to determine the prevalence of air leak syndrome and its outcome in critically ill COVID-19 patients. Materials and methods: The study was planned as a retrospective study and the records of all patients who were critically ill with COVID-19 infection were included. The records of all patients who reported air leaks syndrome were analysed. Details like history, radiology, details of management of cases and, outcome were recorded. Results: Out of 300 cases of critically ill COVID-19, 20 [6.67%] cases developed air leak syndrome. This included four cases (20%) of right-sided pneumothorax, three cases (15%) of left-sided pneumothorax, four cases (20%) of subcutaneous emphysema, and five cases (25%) of pneumomediastinum. Four cases (20%) had multiple site involvement [lung, pneumomediastinum, and subcutaneous emphysema]. Among the 20 patients, 7 patients (35%) survived while 13 died (65%). The highest mortality was observed in patients with left-sided pneumothorax (100%) while isolated pneumomediastinum had the best outcome, where out of 5 patients 4 survived. The pneumomediastinum cases were managed conservatively. All 7 cases of isolated pneumothorax required intercostal drainage (ICD). The patients who had multiple site involvement also required ICD. All the cases of multiple site involvement air leak required ventilatory support (2 needed noninvasive ventilation while the other 2 needed invasive ventilation). Conclusion: In our study, we found air leak syndrome as an important predictor of increased morbidity and mortality. It also poses a challenge for the management of hypoxia and ventilation in the already compromised lungs.