.jpg "Uday Gulati, DO, MS, photo")
Uday Gulati, DO, MS,
Internal Medicine Resident
Inspira Health, United States
Disclosure information not submitted.
Jack Kanoff, DO
Assistant Professor of Pulmonary Medicine
Inspira Health Network, United States
Disclosure information not submitted.
Samson Zarbiv, MD, MPH
Assistant Professor of Medicine, Critical Care Intensivist
Cooper University Health Care, United States
Disclosure information not submitted.
Michael Bonk, MD
Assistant Professor of Medicine, Critical Care Intensivist
Cooper University Health Care, United States
Disclosure information not submitted.
Title: Pneumomediastinum in Patients with Covid-19: An Observational Cohort Study
Introduction: Pneumomediastinum (PMS), a rare occurrence, has been increasingly reported among patients diagnosed with COVID-19. The goal of this study is to report characteristics of COVID-19 patients with PMS and analyze mortality.
Methods: A retrospective analysis was performed on inpatients identified at two hospitals between 01/2020 to 04/2021 who were seropositive for SARS-CoV-2 and who had documented radiologic findings of PMS. Data collected from each medical record included demographics, comorbidities, presence of pneumothorax (PTX), use of positive pressure ventilation (PPV), and mortality at 28 days after diagnosis of PMS. Co-morbidities include obesity, diabetes, hypertension (HTN), and chronic lung disease. Differences in mortality at 28 days after diagnosis were studied using chi-square (χ2) analysis or t-test.
Results: 37 patients met inclusion criteria. Among all included patients, 19 (51.4%) were dead at 28 days after diagnosis of PMS. 10 (27%) patients were diagnosed with PMS without any PPV and 23 (62.2%) without mechanical ventilation, of whom 11 progressed to intubation. 25 (67.6%) patients were intubated during their hospital course and mortality at 28 days after PMS was significantly higher (χ2 =4.937, p=0.026). Of all patients, 12 (32.4%) also had a PTX during the admission but there was no significant 28-day mortality difference (χ2=2.308, p=0.129). Characteristics of patients included mean age 62.03±13.58 years, female (16, 43.2%), male (21, 56.8%), BMI of 30 or higher (20, 54%), HTN (21, 56.8%), diabetes (12, 32.4%), and lung disease (7, 18.9%). At 28 days after diagnosis of PMS, patients who died were significantly older (mean 66.47±16.44 years) than those who lived (mean 57.33±8.39 years; t=2.147, p=0.039). Mortality at 28 days after diagnosis was significantly higher amongst females (χ2=10.431, p=0.015), those with BMI of 30 or higher (χ2=6.0598, p=0.01), and those with lung disease (χ2=4.081, p=0.043). It was not significantly different based on the presence of HTN (χ2=.652, p=0.419) or diabetes (χ2=1.668, p=0.197).
Conclusions: Mechanical ventilation, obesity, older age and female sex are associated with higher mortality in COVID-19 patients with PMS. Notably, in this cohort, the occurrence of PMS can be independent of any PPV, suggestive of COVID-19’s role in precipitating PMS.