Incidence of Air Leak Syndrome in Pediatric Patients with Sars-Cov-2 Pneumonia and Respiratory Failure

ABSTRACT

BACKGROUND AND AIM: Air Leak syndromes (ALS), such as pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum, have been observed in adult patients with respiratory failure secondary to severe acute respiratory syndrome coronavirus-2 SARS-CoV-2 pneumonia with an incidence of approximately ~ 1%. Our aim is to describe the incidence of ALS in children with SARS-CoV-2 pneumonia admitted with respiratory failure to the pediatric intensive care unit (PICU) at 2 large Pediatric Children's Hospitals. METHOD(S) IRB exempted retrospective search of electronic medical record data from patients admitted to the PICUs (Wolfson Children's Hospital and UF Health Shands Children's Hospital) with a diagnosis of SARS-CoV-2 pneumonia with respiratory failure from March 1st, 2020, to December 31, 2021. Diagnosis of SARS-CoV-2 was done with real-time reverse transcriptase PCR performed on nasopharyngeal swab. RESULT(S) 104 patients met criteria for inclusion. The age of the patients ranged from 1 month to 18 years old. Twelve patients (11.5%) presented with or developed ALS including pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum. Of the twelve patients with ALS, three required a chest tube, two were placed on extracorporeal membrane oxygenation (ECMO) and three died. CONCLUSION(S) ALS, with an incidence of 11.5%, are not uncommon in patients with SARS-CoV-2 pneumonia and respiratory failure. ALS contribute to morbidity and was associated with a mortality rate of 25%. To understand if SARS-CoV-2 pneumonia has an intrinsic pathobiology that predispose to ALS, we will perform a propensity score matching with a cohort group considering age-severity of illness and intensity of interventions.