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Bhattarai P, Karki M. Recurrent Spontaneous Pneumothorax in a Young Male With Duchenne Muscular Dystrophy Following COVID-19 Infection. Cureus 2024; 16:e52408. [PMID: 38371092 PMCID: PMC10869316 DOI: 10.7759/cureus.52408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Duchene muscular dystrophy (DMD) is a genetic disorder primarily affecting males. It is characterized by progressive muscle tissue degeneration. Patients with DMD are at an increased risk of respiratory infections, including coronavirus disease 20019 (COVID-19), due to weakened respiratory muscles. We present a case of a young male with DMD who experienced recurrent pneumothorax 10 months after recovering from a COVID-19 infection. The patient required prompt medical intervention, including a chest tube, multiple surgeries, and mechanical pleurodesis. This case highlights the importance of recognizing recurring pneumothorax as a potential complication of COVID-19, particularly in patients with underlying neuromuscular disorders, as it is a medical emergency requiring prompt treatment to prevent respiratory compromise.
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Affiliation(s)
- Pramod Bhattarai
- Pulmonary Medicine, Howard University Hospital, Washington, DC, USA
- Critical Care Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Internal Medicine, Harlem Hospital Center, New York, USA
| | - Monika Karki
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
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2
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Zhong Z, Guo J, Li X, Han Y. Effects of pulmonary air leak on patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. BMC Pulm Med 2023; 23:398. [PMID: 37858100 PMCID: PMC10588255 DOI: 10.1186/s12890-023-02710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has posed increasing challenges to global health systems. We aimed to understand the effects of pulmonary air leak (PAL), including pneumothorax, pneumomediastinum and subcutaneous emphysema, on patients with COVID-19. METHODS We searched PubMed, Embase and Web of Science for data and performed a meta-analysis with a random-effects model using Stata 14.0. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Thirty-five articles were included in the meta-analysis. The data came from 14 countries and included 3,047 COVID-19 patients with PAL, 11,3679 COVID-19 patients without PAL and 361 non-COVID-19 patients with PAL. We found that the incidence of PAL was much higher in COVID-19 patients than in non-COVID-19 patients (odds ratio (OR) = 6.13, 95% CI: 2.09-18.00). We found that the group of COVID-19 patients with PAL had a longer hospital stay (standardized mean difference (SMD) = 0.79, 95% CI: 0.27-1.30) and intensive care unit (ICU) stay (SMD = 0.51, 95% CI: 0.19-0.83) and comprised more ICU (OR = 15.16, 95% CI: 6.51-35.29) and mechanical ventilation patients (OR = 5.52, 95% CI: 1.69-17.99); furthermore, the mortality rate was also higher (OR = 2.62, 95% CI: 1.80-3.82). CONCLUSIONS Patients with lung injuries caused by COVID-19 may develop PAL. COVID-19 patients with PAL require more medical resources, have more serious conditions and have worse clinical outcomes. PROSPERO REGISTRATION NUMBER CRD42022365047.
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Affiliation(s)
- Zhuan Zhong
- The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jia Guo
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xingzhao Li
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yingying Han
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.
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Brogna B, Bignardi E, Megliola A, Laporta A, La Rocca A, Volpe M, Musto LA. A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications. Biomedicines 2023; 11:2113. [PMID: 37626610 PMCID: PMC10452395 DOI: 10.3390/biomedicines11082113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic. Finally, there is a description of vascular extrapulmonary complications, including both ischemic and hemorrhagic abdominal complications.
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Affiliation(s)
- Barbara Brogna
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Elio Bignardi
- Department of Radiology, Francesco Ferrari Hospital, ASL Lecce, 73042 Casarano, Italy;
| | - Antonia Megliola
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Antonietta Laporta
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Andrea La Rocca
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Mena Volpe
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Lanfranco Aquilino Musto
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
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James C, Abdul KA, Bodo B, Abdalla A, Zamora AC, Abraham J, Ganti SS. A Case Series of Spontaneous Pneumomediastinum With/Without Pneumothorax in COVID-19. J Investig Med High Impact Case Rep 2023; 11:23247096231176216. [PMID: 37219068 PMCID: PMC10208980 DOI: 10.1177/23247096231176216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
With the previous worldwide initial coronavirus disease 2019 (COVID-19) pandemic, a notable rise in spontaneous pneumomediastinum with/without pneumothorax (SPP) has been noted. Most cases were initially reported as complications secondary to barotrauma from mechanical ventilation (MV) with COVID-19. However, with the Delta strain, starting from December 2020, there have been multiple reports of SPP. The SPP is an uncommon complication outside use of assisted ventilation with either noninvasive positive pressure ventilation (NIPPV) or MV. COVID-19 has been linked to higher incidence of SPP without use of NIPPV or MV. We present a series of 5 cases with a polymerase chain reaction-confirmed COVID-19 diagnostic testing whose hospital course was complicated by SPP unrelated to the use of either NIPPV or MV.
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AlGhamdi Z, Alqahtani SY, AlDajani K, Alsaedi A, Al-Rubaish O, Alharbi A, Elbawab H. Pneumothorax in Critically Ill COVID-19 Patients: Prevalence, Analysis of Risk Factors and Clinical Outcomes. Int J Gen Med 2022; 15:8249-8256. [PMID: 36438021 PMCID: PMC9698325 DOI: 10.2147/ijgm.s387868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Previous studies have been conducted to assess pneumothorax. However, few studies were done to assess pneumothorax in COVID-19 patients in the intensive care unit (ICU). OBJECTIVE Our aim is to describe and analyze the prevalence, clinical characteristics, risk factors, and outcomes of COVID-19 pneumothorax patients in the intensive care unit. METHODS We performed a retrospective review of the medical records of 418 patients, who tested positive for COVID-19 by polymerase chain reaction test and required ICU admission in King Fahad Hospital of The University from 02/01/2020 to 01/09/2021. A total number of 36 pneumothorax patients were included in the study. RESULTS Of 418 patients who were followed up in the intensive care unit as COVID-19 cases, 36 patients developed a pneumothorax (8.61%). The mean age of the patients was 55.6 ± 15.06 years, 23 patients were male, and 13 were female. Seventeen patients were obese, and only one patient was an active smoker. Twenty-four patients had at least one comorbidity; hypertension was the most common. Thirty-two patients were intubated, and the duration of intubation was 23.23 ±15.9 days. The time from intubation to pneumothorax development was 8.8 ± 9.3 days. Six patients were on bilevel positive airway pressure ventilation (BIPAP), 2 patients on continuous positive airway pressure ventilation (CPAP), 3 patients on High-Flow Nasal Cannula ventilation (HFNC), 9 patients on pressure-control ventilation (PC), and 16 patients on pressure regulated volume control ventilation (PRVC). Of 36 patients, 26 died, and the mortality rate was 72.2%. CONCLUSION Our study showed that risk factors of pneumothorax occurrence in COVID-19 critically ill patients include male patients, hypertension, diabetes mellitus, endotracheal intubation and mechanical ventilation. More efforts should be made to determine the risk factors and assess the outcomes of those patients to develop preventive measures and management guidelines.
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Affiliation(s)
- Zeead AlGhamdi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaya Y Alqahtani
- Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid AlDajani
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ammar Alsaedi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omar Al-Rubaish
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulmajeed Alharbi
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem Elbawab
- Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Muacevic A, Adler JR, Agrawal A, Raj K, Bajaj D, Bhasin S, Bhagat U, Gogia P, Yegneswaran B. Pneumothorax in Intubated Patients With COVID-19: A Case Series. Cureus 2022; 14:e31270. [PMID: 36505163 PMCID: PMC9731936 DOI: 10.7759/cureus.31270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
Pneumothorax is a rare complication among mechanically ventilated patients since low tidal volumes are used nowadays instead of traditional high tidal volumes, but the incidence is slightly higher in patients with high positive end-expiratory pressure (PEEP). Herein we describe a case series of nine patients who were on mechanical ventilation due to acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) and developed pneumothorax in due course. A retrospective analysis was done on COVID-19 intubated patients from March 2020 to June 2020 in a community hospital in Central New Jersey, which was one of the early hit states in the United States at the beginning of the pandemic. Outcomes were studied. The demographics of patients like age, gender, and body mass index (BMI); risk factors like smoking, comorbidities especially chronic lung disease, and the treatment they received were compared. We compared the total number of days on the ventilator, the highest PEEP they received, and the ventilator day when pneumothorax developed. All the patients who developed pneumothorax had a chest tube inserted to treat it. The mortality was noted to be 100% indicating that pneumothorax is a life-threatening complication of COVID-19 and COVID-19 by itself is a risk factor for pneumothorax likely due to a change in lung mechanics. There is a need for large-scale studies to confirm that these outcomes are related to COVID-19.
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Evaluation of Patients Who Developed Pneumothorax Due to COVID-19. Diagnostics (Basel) 2022; 12:diagnostics12092140. [PMID: 36140540 PMCID: PMC9497578 DOI: 10.3390/diagnostics12092140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Although SARS-CoV-2 infection often affects the lungs, pneumothorax is extremely rare. The aim of this study was to analyze the characteristics of patients who were hospitalized due to COVID-19 and who developed pneumothorax (PNX) and to analyze their risk factors. Methods: Patients who developed PNX, among the patients who were followed up in the hospital due to COVID-19 between 1 April 2020 and 1 April 2022, were included in the study. The mean and standard deviation values of the descriptive statistics were obtained from patient data. The entire application was carried out using IBM SPSS 26 (IBM Corp., Armonk, NY, USA). p values < 0.05 were considered statistically significant. Results: We observed that advanced age and male gender increase the risk of COVID-19 patientsdeveloping PNX, but smoking, sepsis, and being followed-up with mechanical ventilation do not increase this risk. In addition, we observed that the presence of an additional disease increases the mortality rate. Conclusion: We show that advanced age and male gender increase the risk for PNX, which is a rare complication of COVID-19, and that comorbidity is associated with mortality in these patients.
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8
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Patel N, Nicolae R, Geropoulos G, Mandal P, Christou CD, Gavala M, Madouros N, Papapanou M, Mogal R, Giannis D, Kechagias KS, Panagiotopoulos N. Pneumomediastinum in the COVID-19 era: to drain or not to drain? Monaldi Arch Chest Dis 2022; 93. [PMID: 35904103 DOI: 10.4081/monaldi.2022.2338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023] Open
Abstract
Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.
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Affiliation(s)
- Nian Patel
- Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London.
| | - Robert Nicolae
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Georgios Geropoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London.
| | - Pallabhi Mandal
- Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London.
| | | | | | | | | | - Rahul Mogal
- Respiratory Medicine Department, Watford General Hospital, West Hertfordshire Hospitals, NHS Foundation Trust, Hertfordshire.
| | | | - Konstantinos S Kechagias
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London.
| | - Nikolaos Panagiotopoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK..
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Prabhakar A, Prabhakar N, Garg M, Kumar A. The Integral Role of Radiology in the Diagnosis and Management of COVID-19-Associated Mucormycosis Infections. Am J Trop Med Hyg 2022; 106:1022-1025. [PMID: 35139486 PMCID: PMC8991342 DOI: 10.4269/ajtmh.21-1135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Recently, there has been a sudden surge in COVID-19-associated mucormycosis (CAM) infections. Rhino-oculo-cerebral and pulmonary mucormycosis are the two most common forms of CAM. Radiology plays an integral role in the management of CAM. Computed tomography (CT) determines gross bony and soft tissue involvement in COVID-19-associated rhino-oculo-cerebral mucormycosis, whereas magnetic resonance imaging helps in evaluation of the orbital and intracranial extension. Paranasal sinus soft tissue with extrasinus infiltration with or without bony destruction is suggestive of COVID-19-associated rhino-oculo-cerebral mucormycosis. High-resolution CT chest scan has shown to be helpful in the diagnosis of COVID-19-associated pulmonary mucormycosis. Consolidation and cavitation are the most common imaging features. Other CT abnormalities include the reverse-halo sign, pleural effusion, ground-glass opacities, pneumothorax, nodules, and pulmonary embolism. A high index of suspicion with appropriate imaging findings can lead to the early diagnosis of CAM and timely initiation of antifungal treatment and/or surgical debridement, which can be lifesaving.
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Shaikh N, Khatib MY, Wraidat MAA, Mohamed AS, Al-Assaf AA, Tharayil AGM, Abujaber AA, Nashwan AJ. Nebulized fentanyl for respiratory symptoms in patients with COVID-19 (ventanyl trial). Medicine (Baltimore) 2022; 101:e28637. [PMID: 35089202 PMCID: PMC8797561 DOI: 10.1097/md.0000000000028637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
Patients with coronavirus disease (COVID-19) commonly experience distressing and challenging respiratory symptoms. Interventions such as oxygen therapy, oral opiates, and traditional nebulizers like ipratropium bromide and salbutamol are variable in their efficacy, and therapy responses in patients are difficult to predict. The purpose of this study is to investigate the efficacy of nebulized fentanyl citrate on dyspnea, cough, and throat pain in patients with COVID-19 and evaluate the safety with any potential adverse events.In COVID-19, about 59% of patients will exhibit cough, 35% generalized body ache and sore throat, and 31% dyspnea. Some methods such as nebulized lidocaine, magnesium sulfate, and systemic opioids have been used to manage the respiratory symptoms. It has been previously shown that fentanyl nebulizer has beneficial effect in improving shortness of breath in patients with chronic obstructive pulmonary disease. The proposed theory behind that was that fentanyl decreased the rate of spontaneous respiratory rate, diminished the brain stem chemoreceptor response to hypoxia and hypercarbia, in addition to exhibiting a modulating effect on the brain stem. Therefore, we hypothesize that nebulized fentanyl has superior effect in improving shortness of breath and relieving cough compared to normal saline, in addition to its advantageous throat pain relief, while exhibiting fewer side effects in patients with COVID 19 infection. Therefore, this phase-III, randomized, comparative, parallel assignment, single-blinded clinical trial aims at assessing the efficacy and safety of nebulized fentanyl to suppress cough, improve breathlessness, and relieve throat pain in patients with COVID-19.
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Jamal W, Sharif M, Sayeed A, Ur Rehman S, Nashwan AJ. Post-COVID-19 pneumonia pneumatoceles: a case report. Eur Clin Respir J 2022; 9:2028423. [PMID: 35059144 PMCID: PMC8765272 DOI: 10.1080/20018525.2022.2028423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Wasim Jamal
- Pulmonology Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Muhammad Sharif
- Pulmonology Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Asma Sayeed
- Family Medicine Department, Primary Health Care Corporation, Doha, Qatar
| | - Saad Ur Rehman
- Family Medicine Department, Primary Health Care Corporation, Doha, Qatar
| | - Abdulqadir J. Nashwan
- Nursing Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
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12
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Marza AM, Petrica A, Lungeanu D, Sutoi D, Mocanu A, Petrache I, Mederle OA. Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection. Int J Gen Med 2022; 15:489-500. [PMID: 35046709 PMCID: PMC8760984 DOI: 10.2147/ijgm.s347178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Spontaneous pneumothorax (SP) and spontaneous pneumomediastinum (SPM) have frequently been cited as complications associated with coronavirus disease 2019 (COVID-19) pneumonia, with especially poor prognosis in mechanically ventilated patients. The current literature is controversial regarding the potential risk factors for developing SP or SPM (SP-SPM) in non-ventilated COVID-19 patients. Our research addressed a twofold objective: (a) to investigate the characteristics of patients with SP-SPM (both with and without COVID-19) and compare them to patients with sole COVID-19; (b) to quantify the risk of in-hospital mortality associated with SP-SPM and COVID-19. Patients and Methods A retrospective case–control study was conducted in the emergency departments (ED) of two tertiary hospitals in Timisoara, Romania, over one year (1st April 2020‒31st March 2021; 64,845 records in total) and 70 cases of SP-SPM were identified (both SARS-CoV-2 positives and negatives). The control group comprised COVID-19 patients with no SP-SPM, included at a 2:1 ratio. Logistic regression was employed to quantify the in-hospital mortality risk associated with age, SP-SPM, and COVID-19. Results SP-SPM and COVID-19 were connected with prolonged hospitalization, a higher percentage of intensive care admission, and a higher mortality. SP-SPM increased the odds of death by almost four times in patients of the same age, gender, smoking status, and SARS-CoV-2 infection: OR = 3.758, 95% CI (1.443–9.792). Each additional year of age added 9.4% to the mortality risk: OR = 1.094, 95% CI (1.054–1.135). Conclusion ED physicians should acknowledge these potential risks when attending COVID-19 patients with SP-SPM.
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Affiliation(s)
- Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
- Correspondence: Alina Petrica Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, RomaniaTel +40744772427 Email
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Diana Lungeanu Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, Romania Email
| | - Dumitru Sutoi
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Anaesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
| | - Alexandra Mocanu
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Ioan Petrache
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Thoracic Surgery, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
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