Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes

ABSTRACT

Background

Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients.

Research design and methods

A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020–06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE

Results

1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19–21.59) and ICU admission of 9.14 (95%CI, 5.3–12.78) compared to the unaffected group.

Conclusion

Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.

KEYWORDS:

• Pneumothorax
• pneumomediastinum
• subcutaneous emphysema
• COVID-19
• SARS-CoV-2

Author contributions

Aleksandra Murawska Baptista: Conceptualization, Methodology, Writing – Review & Editing. Jorge E. Sinclair De Frias: Conceptualization, Methodology, Investigation, Data Curation, Writing – Original Draft. Trisha Singh: Conceptualization, Investigation, Writing – Original Draft. Ananya Vasudhar: Investigation, Writing – Original Draft, Jacob Guzzino: Investigation, Writing – Original Draft. Waheed Khalili: Investigation, Writing – Original Draft. Aysun Tekin: Investigation, Writing – Review & Editing. Vikas Bansal: Investigation, Writing – Review & Editing. Rahul Kashyap: Investigation, Writing – Review & Editing. William J. Joyce: Conceptualization, Writing – Review & Editing. Patricia A. Lewis: Conceptualization, Writing – Review & Editing. Devang Sanghavi: Investigation, Writing – Review & Editing. Tatjana Gavrancic: Conceptualization, Methodology, Writing – Review & Editing. Pablo Moreno Franco: Conceptualization, Methodology, Supervision, Writing – Review & Editing.

Declaration of interest

Rahul Kashyap: Grants or contracts – Gordan and Betty Moore Foundation, Jenssen and Jenssen LLC; payments were made to the institution. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Meeting presentation

Poster presentation at the American Thoracic Society 2023 International Conference in Washington, DC, from May 19 – 24, 2023.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2254689

Additional information

Funding

This paper was not funded.