Pneumopericardium in Covid-19: A Systematic Review

ABSTRACT

INTRODUCTION: COVID-19 can manifest in the lungs as acute respiratory distress syndrome leading to poor lung compliance and increasing susceptibility to barotrauma, which is hypothesized to cause an airleak resulting in pneumomediastinum (PM) and pneumothorax (PTX). Pneumopericardium (PP), a more rare complication, has been documented in relatively few cases to date. This study sought to review the relationship between positive pressure ventilation (PPV) and development of PP and to survey treatment options for COVID-19 patients with PP. METHOD(S) A systematic search was conducted on full text articles, including case reports and case series, for COVID-19 patients with comorbid PP from January 1st, 2019 to April 12th, 2022. Demographic data, presence of PM, PTX, PP and subcutaneous emphysema (SE), treatment information regarding respiratory support, use of steroids and other medications were recorded along with in-hospital mortality. RESULT(S) 51 articles met final inclusion criteria, reporting 76 cases of COVID-19 patients with PP. The average age was 54.5 years with a range of 17-82. Fifty-eight (76.3%) patients were male. 27 (35.5%) patients with PP died. PP occurred in isolation in 5 (6.6%) patients. PP was most comorbid with PM (n=65, 85.5%). SE occurred in 44 (57.9%) patients and PTX in 25 (32.9%) patients. 18 (23.7%) patients developed all of the sequalae of airleak. 64 (84.2%) patients received some degree of respiratory support 35 (46.1%) patient's maximum support was supplemental oxygen, six (7.9%) were on non-invasive PPV, and 22 (28.9%) required mechanical ventilation. 29 (38.2%) patients with PP were given steroids. Only 1 patient received pericardiocentesis for presumed tamponade physiology. CONCLUSION(S) There was a high mortality in COVID-19 patients with PP. Previous reports hypothesized that PPV may be the etiology of PP in COVID-19 patients;however, only 36.8% of patients with PP in this review received PPV. It is unclear if the COVID-19 patients with PP not receiving PPV had tachypnea causing air trapping thus leading to self-induced barotrauma. Decompressive maneuvers have been studied in PTX and PM, however only one patient in this review received pericardiocentesis. Further research is needed to provide further etiology and treatment guidelines as this pandemic continues.