Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation

• Published in: BMJ case reports Vol. 14; no. 3; p. e241809
• Main Authors: Thein, Onn Shaun, Niazi, Muhammad, Ali, Abdisamad, Sahal, Adeel
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 23.03.2021; BMJ Publishing Group
• Subjects: Aged, 80 and over; Antibiotics; Arthritis; Auscultation; Blood pressure; Cardiac arrhythmia; Case Report; Case reports; Conservative Treatment; Coronaviruses; COVID-19; COVID-19 - therapy; Diagnosis, Differential; Emphysema; Fatal Outcome; Female; Heart rate; Humans; Male; Mediastinal Emphysema - diagnostic imaging; Mediastinal Emphysema - etiology; Mediastinal Emphysema - therapy; Middle Aged; Noninvasive Ventilation - adverse effects; Osteoarthritis; Oxygen therapy; Palliative care; Pandemics; Patients; Pneumonia; Pneumothorax; Positive-Pressure Respiration - adverse effects; Pulmonary embolisms; Radiography; Respiratory distress syndrome; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tomography, X-Ray Computed; Ventilators; COVID-19; pneumonia (infectious disease); CPAP; pneumonia (respiratory medicine)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-241809

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.