Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit

• Published in: Journal of intensive care medicine Vol. 38; no. 11; p. 1023
• Main Authors: Lorente-González, Miguel, Terán-Tinedo, José Rafael, Zevallos-Villegas, Annette, Laorden, Daniel, Mariscal-Aguilar, Pablo, Suárez-Ortiz, Miguel, Cano-Sanz, Eduardo, Ortega-Fraile, María Ángeles, Hernández-Núñez, Joaquín, Falcone, Adalgisa, Saiz-Lou, Elena María, Plaza-Moreno, María Cristina, García-Fadul, Christian, Valle-Falcones, Manuel, Sánchez-Azofra, Ana, Funes-Moreno, Clotilde, De-La-Calle-Gil, Isabel, Navarro-Casado, Rosalía, Carballo-López, Daniel, Gholamian-Ovejero, Soraya, Gallego-Rodríguez, Berta, Villén-Villegas, Tomás, Landete, Pedro
• Format: Journal Article
• Language: English
• Published: United States 01.11.2023
• Subjects: COVID-19 - complications; COVID-19 - therapy; Humans; Mediastinal Emphysema - etiology; Mediastinal Emphysema - therapy; Noninvasive Ventilation; Oxygen Inhalation Therapy; Pneumonia; Pneumothorax - epidemiology; Pneumothorax - etiology; Pneumothorax - therapy; Respiratory Care Units; Respiratory Insufficiency - therapy; SARS-CoV-2; COVID-19; noninvasive respiratory support; intermediate respiratory care unit; mortality; pneumomediastinum; SARS-CoV-2 pneumonia; invasive mechanical ventilation; incidence; pneumothorax
• ISSN: 1525-1489
• DOI: 10.1177/08850666231180165

The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55;  < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68;  < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50;  < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85;  < .001), while it was 10.5% (131/1250) among patients without PM and PTX. In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.