tetano
Editor, Senior Moderator
J Clin Med
. 2021 Oct 21;10(21):4835.
doi: 10.3390/jcm10214835.
Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
Matteo Bonato[SUP] 1 2 [/SUP], Alessia Fraccaro[SUP] 1 [/SUP], Nicholas Landini[SUP] 3 [/SUP], Giuseppe Zanardi[SUP] 1 [/SUP], Cosimo Catino[SUP] 1 [/SUP], Francesca Savoia[SUP] 1 [/SUP], Nicola Malacchini[SUP] 1 [/SUP], Fabiola Zeraj[SUP] 1 [/SUP], Piera Peditto[SUP] 1 [/SUP], Vito Catalanotti[SUP] 4 [/SUP], Elisabetta Marcon[SUP] 5 [/SUP], Emanuela Rossi[SUP] 6 [/SUP], Alessia Pauletti[SUP] 6 [/SUP], Silvia Galvan[SUP] 7 [/SUP], Riccardo Adami[SUP] 8 [/SUP], Marta Tiepolo[SUP] 9 [/SUP], Mauro Salasnich[SUP] 1 [/SUP], Maria Cuzzola[SUP] 1 [/SUP], Francesca Zampieri[SUP] 1 [/SUP], Marcello Rattazzi[SUP] 9 [/SUP], Mario Peta[SUP] 10 [/SUP], Simonetta Baraldo[SUP] 2 [/SUP], Marina Saetta[SUP] 2 [/SUP], Giovanni Morana[SUP] 3 [/SUP], Micaela Romagnoli[SUP] 1 [/SUP]
Affiliations
Abstract
Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients' outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM.
Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared.
Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017).
Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
Keywords: ARDS; COVID-19; SARS-CoV-2; case-control; coronavirus; pneumomediastinum; pneumothorax.
. 2021 Oct 21;10(21):4835.
doi: 10.3390/jcm10214835.
Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
Matteo Bonato[SUP] 1 2 [/SUP], Alessia Fraccaro[SUP] 1 [/SUP], Nicholas Landini[SUP] 3 [/SUP], Giuseppe Zanardi[SUP] 1 [/SUP], Cosimo Catino[SUP] 1 [/SUP], Francesca Savoia[SUP] 1 [/SUP], Nicola Malacchini[SUP] 1 [/SUP], Fabiola Zeraj[SUP] 1 [/SUP], Piera Peditto[SUP] 1 [/SUP], Vito Catalanotti[SUP] 4 [/SUP], Elisabetta Marcon[SUP] 5 [/SUP], Emanuela Rossi[SUP] 6 [/SUP], Alessia Pauletti[SUP] 6 [/SUP], Silvia Galvan[SUP] 7 [/SUP], Riccardo Adami[SUP] 8 [/SUP], Marta Tiepolo[SUP] 9 [/SUP], Mauro Salasnich[SUP] 1 [/SUP], Maria Cuzzola[SUP] 1 [/SUP], Francesca Zampieri[SUP] 1 [/SUP], Marcello Rattazzi[SUP] 9 [/SUP], Mario Peta[SUP] 10 [/SUP], Simonetta Baraldo[SUP] 2 [/SUP], Marina Saetta[SUP] 2 [/SUP], Giovanni Morana[SUP] 3 [/SUP], Micaela Romagnoli[SUP] 1 [/SUP]
Affiliations
- PMID: 34768352
- DOI: 10.3390/jcm10214835
Abstract
Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients' outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM.
Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared.
Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017).
Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
Keywords: ARDS; COVID-19; SARS-CoV-2; case-control; coronavirus; pneumomediastinum; pneumothorax.