Pneumothorax emerging as a new complication of COVID-19, reports study

The findings of the study have been published in the European Respiratory Journal.

The collection of air in the pleural cavity and the subsequent collapse of the lungs is a condition known as pneumothorax. Pneumomediastinum is the presence of gas or free air in the mediastinum. Spontaneous pneumothorax was reported as a complication of severe acute respiratory syndrome (SARS, caused by SARS-CoV-1) with an incidence of 1.7% in hospitalized patients. Pneumothorax has been reported in a small number of patients COVID-19, though the significance and frequency of this association remain unclear.

The present study, by Anthony W. Martinelli et al, at Addenbrooke's Hospital, Cambridge, United Kingdom aimed to describe the clinical characteristics of patients with these pathologies and consider whether the development of pneumothorax can be used as a marker of poor prognosis.

Sample Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management, and survival.

A total of 71 patients were reviewed, of whom 60 patients had pneumothoraces (six also with pneumomediastinum), whilst 11 patients had pneumomediastinum alone. Two patients had two distinct episodes of pneumothorax, occurring bilaterally in a sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to the hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complications whilst intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation.

Results revealed the following facts.

• Of the 60 patients with pneumothorax, 58 were laboratory confirmed COVID-19 infection with two diagnosed based on clinical history and radiology. Sixty-one pneumothoraces were confirmed by chest radiograph, whilst one case was diagnosed by suspicious radiology before deterioration.
• Survival at 28 days was not significantly different following pneumothorax (63.1%±6.5%) or isolated pneumomediastinum (53.0%±18.7%; p=0.854).
• The incidence of pneumothorax was higher in males. The 28-day survival was not different between the sexes (males 62.5%±7.7% versus females 68.4%±10.7%; p=0.619).
• Patients above the age of 70 had a significantly lower 28-day survival than younger individuals (≥70 years 41.7%±13.5% survival versus <70 years 70.9%±6.8% survival; p=0.018 log-rank).

"We have described the largest series of pneumothoraces in the context of COVID-19 that includes non-ventilated patients. Although heterogeneous, these cases provide important insights into the association between pneumothorax and COVID-19." wrote the team.

Primary source: European Respiratory Journal

For the full article follow the link: 10.1183/13993003.02697-2020