A case of successful pregnancy managed in a patient living with Motor Neurone Disease for more than 3 years.

A woman in her 20s presented with progressive weakness of her left arm and leg, slurred speech and swallowing difficulties. The clinical presentation and neurophysiological tests were consistent with motor neuron disease. She was referred to the regional ventilation unit for respiratory muscle function testing. This confirmed restrictive spirometry and borderline sniff nasal inspiratory pressure and cough peak expiratory flow. Three years later, she presented with an unplanned pregnancy and expressed the wish to continue the pregnancy to term. She was monitored throughout pregnancy with interval respiratory muscle testing and was reviewed in the high-risk pregnancy anaesthetic clinic. She was also closely monitored by the obstetrics and gynaecology team. A multidisciplinary team meeting between all stakeholders agreed on caesarean section delivery at 34 weeks. The pregnancy and the delivery were without complications; the baby was healthy and both mother and baby remain well to date.

Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation.

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.