tetano
Editor, Senior Moderator
Eur Respir J
. 2022 Feb 10;2102522.
doi: 10.1183/13993003.02522-2021. Online ahead of print.
Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey
James Melhorn[SUP] 1 2 3 4 [/SUP], Andrew Achaiah[SUP] 3 5 [/SUP], Francesca M Conway[SUP] 6 [/SUP], Elizabeth M F Thompson[SUP] 7 [/SUP], Erik W Skyllberg[SUP] 8 [/SUP], Joseph Durrant[SUP] 8 [/SUP], Neda A Hasan[SUP] 9 [/SUP], Yasser Madani[SUP] 9 [/SUP], Prasheena Naran[SUP] 10 [/SUP], Bavithra Vijayakumar[SUP] 6 11 [/SUP], Matthew J Tate[SUP] 12 [/SUP], Gareth E Trevelyan[SUP] 13 [/SUP], Irfan Zaki[SUP] 13 [/SUP], Catherine A Doig[SUP] 14 [/SUP], Geraldine Lynch[SUP] 15 [/SUP], Gill Warwick[SUP] 16 [/SUP], Avinash Aujayeb[SUP] 17 [/SUP], Karl A Jackson[SUP] 17 [/SUP], Hina Iftikhar[SUP] 18 [/SUP], Jonathan H Noble[SUP] 18 [/SUP], Anthony Y K C Ng[SUP] 19 [/SUP], Mark Nugent[SUP] 20 [/SUP], Philip J Evans[SUP] 20 [/SUP], Robert A Hastings[SUP] 21 [/SUP], Harry R Bellenberg[SUP] 21 [/SUP], Hannah Lawrence[SUP] 22 [/SUP], Rachel L Saville[SUP] 22 [/SUP], Nikolas T Johl[SUP] 23 [/SUP], Adam N Grey[SUP] 23 [/SUP], Huw C Ellis[SUP] 24 [/SUP], Cheng Chen[SUP] 24 [/SUP], Thomas L Jones[SUP] 25 [/SUP], Nadeem Maddekar[SUP] 26 [/SUP], Shahul Leyakathali Khan[SUP] 26 [/SUP], Ambreen Iqbal Muhammad[SUP] 27 [/SUP], Hakim Ghani[SUP] 27 [/SUP], Yadee Maung Maung Myint[SUP] 27 [/SUP], Cecillia Rafique[SUP] 28 [/SUP], Benjamin J Pippard[SUP] 28 [/SUP], Benjamin R H Irving[SUP] 29 [/SUP], Fawad Ali[SUP] 30 [/SUP], Viola H Asimba[SUP] 31 [/SUP], Aqeem Azam[SUP] 32 [/SUP], Eleanor C Barton[SUP] 33 [/SUP], Malvika Bhatnagar[SUP] 34 [/SUP], Matthew P Blackburn[SUP] 35 [/SUP], Kate J Millington[SUP] 36 [/SUP], Nicholas J Budhram[SUP] 36 [/SUP], Katherine L Bunclark[SUP] 37 [/SUP], Toshit P Sapkal[SUP] 37 [/SUP], Giles Dixon[SUP] 38 [/SUP], Andrew J E Harries[SUP] 39 [/SUP], Mohammad Ijaz[SUP] 40 [/SUP], Vijayalakshmi Karunanithi[SUP] 41 [/SUP], Samir Naik[SUP] 41 [/SUP], Malik Aamaz Khan[SUP] 42 [/SUP], Karishma Savlani[SUP] 42 [/SUP], Vimal Kumar[SUP] 43 [/SUP], Beatriz Lara Gallego[SUP] 44 [/SUP], Noor A Mahdi[SUP] 45 [/SUP], Caitlin Morgan[SUP] 46 [/SUP], Neena Patel[SUP] 47 [/SUP], Elen W Rowlands[SUP] 48 [/SUP], Matthew S Steward[SUP] 49 [/SUP], Richard S Thorley[SUP] 50 [/SUP], Rebecca L Wollerton[SUP] 50 [/SUP], Sana Ullah[SUP] 51 [/SUP], David M Smith[SUP] 52 [/SUP], Wojciech Lason[SUP] 53 [/SUP], Anthony J Rostron[SUP] 52 [/SUP], Najib M Rahman[SUP] 2 54 [/SUP], Rob J Hallifax[SUP] 53 3 [/SUP]
Affiliations
Abstract
Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.
Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.
Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.
Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.
. 2022 Feb 10;2102522.
doi: 10.1183/13993003.02522-2021. Online ahead of print.
Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey
James Melhorn[SUP] 1 2 3 4 [/SUP], Andrew Achaiah[SUP] 3 5 [/SUP], Francesca M Conway[SUP] 6 [/SUP], Elizabeth M F Thompson[SUP] 7 [/SUP], Erik W Skyllberg[SUP] 8 [/SUP], Joseph Durrant[SUP] 8 [/SUP], Neda A Hasan[SUP] 9 [/SUP], Yasser Madani[SUP] 9 [/SUP], Prasheena Naran[SUP] 10 [/SUP], Bavithra Vijayakumar[SUP] 6 11 [/SUP], Matthew J Tate[SUP] 12 [/SUP], Gareth E Trevelyan[SUP] 13 [/SUP], Irfan Zaki[SUP] 13 [/SUP], Catherine A Doig[SUP] 14 [/SUP], Geraldine Lynch[SUP] 15 [/SUP], Gill Warwick[SUP] 16 [/SUP], Avinash Aujayeb[SUP] 17 [/SUP], Karl A Jackson[SUP] 17 [/SUP], Hina Iftikhar[SUP] 18 [/SUP], Jonathan H Noble[SUP] 18 [/SUP], Anthony Y K C Ng[SUP] 19 [/SUP], Mark Nugent[SUP] 20 [/SUP], Philip J Evans[SUP] 20 [/SUP], Robert A Hastings[SUP] 21 [/SUP], Harry R Bellenberg[SUP] 21 [/SUP], Hannah Lawrence[SUP] 22 [/SUP], Rachel L Saville[SUP] 22 [/SUP], Nikolas T Johl[SUP] 23 [/SUP], Adam N Grey[SUP] 23 [/SUP], Huw C Ellis[SUP] 24 [/SUP], Cheng Chen[SUP] 24 [/SUP], Thomas L Jones[SUP] 25 [/SUP], Nadeem Maddekar[SUP] 26 [/SUP], Shahul Leyakathali Khan[SUP] 26 [/SUP], Ambreen Iqbal Muhammad[SUP] 27 [/SUP], Hakim Ghani[SUP] 27 [/SUP], Yadee Maung Maung Myint[SUP] 27 [/SUP], Cecillia Rafique[SUP] 28 [/SUP], Benjamin J Pippard[SUP] 28 [/SUP], Benjamin R H Irving[SUP] 29 [/SUP], Fawad Ali[SUP] 30 [/SUP], Viola H Asimba[SUP] 31 [/SUP], Aqeem Azam[SUP] 32 [/SUP], Eleanor C Barton[SUP] 33 [/SUP], Malvika Bhatnagar[SUP] 34 [/SUP], Matthew P Blackburn[SUP] 35 [/SUP], Kate J Millington[SUP] 36 [/SUP], Nicholas J Budhram[SUP] 36 [/SUP], Katherine L Bunclark[SUP] 37 [/SUP], Toshit P Sapkal[SUP] 37 [/SUP], Giles Dixon[SUP] 38 [/SUP], Andrew J E Harries[SUP] 39 [/SUP], Mohammad Ijaz[SUP] 40 [/SUP], Vijayalakshmi Karunanithi[SUP] 41 [/SUP], Samir Naik[SUP] 41 [/SUP], Malik Aamaz Khan[SUP] 42 [/SUP], Karishma Savlani[SUP] 42 [/SUP], Vimal Kumar[SUP] 43 [/SUP], Beatriz Lara Gallego[SUP] 44 [/SUP], Noor A Mahdi[SUP] 45 [/SUP], Caitlin Morgan[SUP] 46 [/SUP], Neena Patel[SUP] 47 [/SUP], Elen W Rowlands[SUP] 48 [/SUP], Matthew S Steward[SUP] 49 [/SUP], Richard S Thorley[SUP] 50 [/SUP], Rebecca L Wollerton[SUP] 50 [/SUP], Sana Ullah[SUP] 51 [/SUP], David M Smith[SUP] 52 [/SUP], Wojciech Lason[SUP] 53 [/SUP], Anthony J Rostron[SUP] 52 [/SUP], Najib M Rahman[SUP] 2 54 [/SUP], Rob J Hallifax[SUP] 53 3 [/SUP]
Affiliations
- PMID: 35144988
- DOI: 10.1183/13993003.02522-2021
Abstract
Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.
Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.
Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.
Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.