Spontaneous pneumothorax in critically ill patients with COVID-19

Abstract

Background & Objective: Coronavirus disease 2019 (COVID-19) claimed thousands of the lives during a limited period of time, but also enriched our scientific knowledge, especially regarding the respiratory pathogenesis and intensive care dynamics. This study was carried out to bridge the gap in the literature regarding the incidence, clinical features, and outcomes of spontaneous pneumothorax (SP) that develops during the course of COVID-19.

Methodology: The population of this single-center retrospective study consisted of all critically ill adult patients who tested positive for COVID-19, developed SP, and were admitted to the intensive care units (ICUs) of Acibadem University School of Medicine, Training and Research Hospital, between March 21, 2020 and May 31, 2021. Detailed medical records, clinical findings, chest computed tomography (CT) scans, and X-ray images of critically ill COVID-19 patients complicated by SP were obtained and analyzed.

Results: Of the 753 patients admitted to the ICUs during the study period, 600 tested positive for COVID-19 viral pneumonia. Of these patients, 549 met the diagnostic criteria for acute respiratory distress syndrome (ARDS), of whom 472 were treated with invasive mechanical ventilation (IMV) and 77 were treated without IMV. SP developed in a total of five (0.8%) patients, 4 (0.9%) of whom were on IMV support and 1 (1.2%) of whom was breathing spontaneously. Of these patients who developed SP, one patient on IMV support was female, and the remaining four were male. The median age of these five patients was 42 (33-64) years. Two (40%) of the five patients died in ICU.

Conclusion: The actual incidence of COVID-19-related spontaneous pneumothorax is yet to be elucidated and may require a large scale, multi-center study. COVID-19-related spontaneous pneumothorax is similar to ARDS-related spontaneous pneumothorax without COVID-19 in terms of clinical features and outcomes, its risk of occurrence is higher.

Abbreviations: COVID-19 - Coronavirus disease 2019; CT - computed tomography; IMV - invasive mechanical ventilation; SP - spontaneous pneumothorax

Keywords: SARS-Cov-2; COVID-19; Spontaneous Pneumothorax

Citation: Heppekcan D, Hazar EU. Spontaneous pneumothorax in critically ill patients with COVID-19. Anaesth. pain intensive care 2024;28(4):646−651; DOI: 10.35975/apic.v28i4.2506

Received: May 15, 2024; Reviewed: June 01, 2024; Accepted: June 22, 2024