Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India

• Published in: Clinical medicine (London, England) Vol. 21; no. 6; pp. e615 - e619
• Main Authors: Udwadia, Zarir F, Toraskar, Kedar K, Pinto, Lancelot, Mullerpatan, Jai, Wagh, Haresh D, Mascarenhas, Joanne M, Gandhi, Bhavesh M, Tripathi, Awatansh, Sunavala, Ayesha, Agrawal, Umang, Nanda, Viral, Abraham, Nikita, Francis, Bony, Zore, Ravindra R, Pundpal, Gurudas, Gondse, Bhoosan, Gupta, Gaurav A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2021; Royal College of Physicians
• Subjects: air leak in COVID-19; barotrauma in COVID-19; COVID-19; Humans; Intensive Care Units; Mediastinal Emphysema - diagnostic imaging; Mediastinal Emphysema - epidemiology; Original Research; pneumomediastinum; pneumothorax; Pneumothorax - diagnostic imaging; Pneumothorax - epidemiology; Retrospective Studies; SARS-CoV-2; air leak in COVID-19; pneumomediastinum; barotrauma in COVID-19; pneumothorax
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmed.2021-0220

There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001). Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.