Heidy Izquierdo, MD
Internal Medicine Resident
Kendall Regional Medical Center
Miami, Florida
Disclosure information not submitted.
David Cotto, MD
Internal Medicine Resident
Kendall Regional Medical Center
Miami, Florida, United States
Disclosure information not submitted.
Ilde Lee, MD
Intensivist
Kendall Regional Medical Center
Miami, Florida, United States
Disclosure information not submitted.
Sabrina Arshed, MD
Intensivist
Kendall Regional Medical Center
Miami, Florida, United States
Disclosure information not submitted.
Title: Spontaneous Pneumomediastinum and Pneumothorax in COVID-19 patients
Introduction: Less than a year ago the World Health Organization officially declared Coronavirus19 (COVID-19) a pandemic, and over 35 million cases have been diagnosed in the United States as of 8/1/21. In patients with COVID-19 pneumonia, spontaneous pneumomediastinum (SPM) and spontaneous pneumothorax (SPT) have occurred more frequently. Our aim is to determine the incidence, risk factors and associated mortality of SPM/SPT in COVID-19 patients.
Methods: We performed a single-center, retrospective observational analysis of patients presenting with SPM/SPT. A total of 219 patients were admitted to the ICU with COVID-19 between June 2020-November 2020. Of these, 35 cases had developed either SPM and/or SPT. Primary outcome is 60-day mortality. Secondary outcomes include mode of ventilation prior to the development of SPM/SPT and ICU length of stay (ICULOS)
Results: 219 patients were admitted to the ICU from June 2020-November 2020. 35 (15.98%) developed SPM/SPT. Of these 35 patients, 21(60%) had SPT/SPM, 12(34%) had SPT alone, and 2(5.7%) had SPM alone. Of the 35 patients admitted to the ICU with SPM/SPT, 28(80%) died within 60 days, 1(2.8%) patient was discharged to LTAC. 1(2.8%) patient was discharged home, and 5(14%) were made hospice. Prior to developing SPT/SPM, 17(48%) patients required invasive mechanical ventilation; while 12(34%) were on HFNC + NRB mask, and 6(17%) required non-invasive positive pressure ventilation.. 30(85%) patients developed SPM/SPT after admission to ICU. 5(14%) of patients developed SPM/SPT prior to ICU admission. Patients with SPM/SPT had an ICULOS of 2-58 days with an average of 16.7 days. The incidence of SPM/SPT was higher in males 27(77%) .
Conclusion: Although we do not fully understand the pathophysiology of how COVID-19 increases the risk of SPT/SPM, some experts hypothesize that it is the high inflammatory response that might result in cyst formation due to inflammatory exudate and creating the lung damage we see on those patients. Another theory is the damage caused by the COVID-19 to the lung parenchyma and interstitium, weaken its structure, leading to alveolar rupture. Some experts described the Macklin Effect as the main pathophysiologic cause of pneumomediastinum in COVID-19 with ARDS. Nonetheless, our study suggests a high mortality after developing SPM/SPT.