Spontaneous pneumothorax: An emerging complication of COVID-19 pneumonia

Abstract

Spontaneous Pneumothorax in the setting of coronavirus disease 19 (COVID-19) has been rarely described and is a potentially lethal complication. We report our institutional experience. Patients with confirmed COVID-19 who were admitted at 5 hospitals within the Inova health system between February 21 and May 2020 were included in the study. We identified 1619 patients, 22 patients (1.4%) developed spontaneous pneumothorax during their hospitalization without evidence of traumatic injury.

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

“…The third-largest study was by Ekanem et al, describing 1,619 COVID-19 patients with an incidence of pneumothorax at 1.4%, and 40.9% of COVID-19 patients were mechanically ventilated before the diagnosis of pneumothorax. 15 A single-center study by Wang et al revealed that although the incidence of pneumothorax was low at 2.0% (5/248) among hospitalized COVID-19 patients, all patients who developed pneumothoraces were critically ill [23.8% (5/21)] and universally required mechanically ventilated (100%). 19 COVID-19-Related Pneumothorax Characteristics:…”

“…Five observational studies (Table 1) exclusively described the gender of hospitalized COVID-19 patients who developed pneumothoraces in which most were male [76.7% (102/133]. [14][15][16]19,20 Among the four observational studies describing the locality of pneumothorax, COVID-19related pneumothorax was commonly unilateral and predominantly right-sided in 56.9% (74/130) of cases. 13,14,19,20 Moreover, chest tube insertion was required in up to 64.0% (87/136) of COVID-19 patients who developed pneumothoraces for the management of pneumothoraces according to five observational studies.…”

“…13,14,19,20 Moreover, chest tube insertion was required in up to 64.0% (87/136) of COVID-19 patients who developed pneumothoraces for the management of pneumothoraces according to five observational studies. [14][15][16]19,20 According to three observational studies, less than 20% of hospitalized COVID-19 patients developed pneumomediastinum concurrently with pneumothoraces (Table 1). 14,16,19 Risk Factors for COVID-19-Related Pneumothorax: According to the nine observational studies, the mean/median age groups of COVID-19 patients were between 55 to 70 years of age.…”

“…Moreover, four observational studies revealed that less than 34% of COVID-19 patients diagnosed with pneumothoraces were smokers. [13][14][15][16] Two retrospective observational studies (Table 4) assessed the different respiratory variables among mechanically ventilated COVID-19 patients who developed pneumothoraces in which ventilator parameters involving peak inspiratory pressure (range 23.7-24.3 cmH2O), plateau pressure (less than 30 cmH2O), PEEP (range 10.6-10.7 cmH2O), TV [437.5 ml (5.4 ml/kg)] were not elevated. 19,20 However, elevated baseline RR was observed in few studies included.…”

“…The overall mortality rate of COVID-19 patients diagnosed with pneumothoraces was up to 74.2% (69/93). 15,16,19,20 A multi-center, retrospective cohort study by Martinelli et al reported the highest mortality rate among COVID-19 patients diagnosed with pneumothoraces at 88.3%. Although there was no difference in gender and IMV requirement among survivors and non-survivors, COVID-19 patients with pneumothoraces who were acidotic and aged 70 and older had a higher mortality rate observed during subgroup analysis (P < 0.05).…”