Spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in non-intubated patients with COVID-19 pneumonitis: a retrospective case note review of a single centre experience

ABSTRACT

Introduction: Emerging evidence suggests COVID-19 is associated with a higher incidence of pneumomediastinum (PM), subcutaneous emphysema (SCE) and pneumothorax (PTX). Aims and objectives: To determine whether the presence of concurrent SCE and PTX in addition to PM were associated with a higher risk of admission to ITU or death compared to PM alone. Method(s) Study period September 2020 to June 2021. Patients identified through the Trust Operations Centre prospective records of all COVID-19 admissions. PACS radiology system used to further identify patients who had CT scans. Every CT scan reviewed for presence of PM, SCE and PTX. Case notes reviewed retrospectively. Statistical analyses GraphPad Prism;group difference assessments Kruskal-Wallis tests. Result(s) PM was confirmed on CT scans in 24 patients. Mean age was 63.29 years (SD+/-10.05). 66.7% were male. 83.3% required CPAP;12.5% venturi masks and 4.2% optiflow. In addition to PM, 11 patients had SCE, 8 had PTX and 4 pneumopericardium. There was no significant difference in admission SpO2, maximum FiO2 and maximum PEEP in PM patients who developed SCE or PTX (p=0.94 and 0.91) versus PM alone. ~40% of patients in each group developed pneumonia or sepsis. Higher percentages of SCE or PTX patients were admitted to ITU (81.7% and 87.5%) compared to PM alone (62.5%), however this was not statistically significant, nor associated with higher risk of death (p=0.10;p=0.89 respectively). Conclusion(s) PM patients with and without SCE and PTX had no significant differences in respiratory support mechanisms, PEEP, FiO2, ITU admission or risk of death.