Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study
Aysun Tekin,
Anusha Devarajan,
Kenneth K. Sakata,
Shahraz Qamar,
Mayank Sharma,
Diana J. Valencia Morales,
Michael Malinchoc,
Fahimeh Talaei,
Stephanie Welle,
Jamil Taji,
Sandeep Khosa,
Nikhil Sharma,
Meghan Brown,
Amos Lal,
Vikas Bansal,
Syed Anjum Khan,
Abigail T. La Nou,
Devang Sanghavi,
Rodrigo Cartin-Ceba,
Rahul Kashyap,
Ognjen Gajic,
Juan P. Domecq,
Natalya Azadeh
Affiliations
Aysun Tekin
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Anusha Devarajan
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
Kenneth K. Sakata
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
Shahraz Qamar
Post-Baccalaureate Research Education Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
Mayank Sharma
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Diana J. Valencia Morales
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Michael Malinchoc
Malinchoc Research Consulting, LLC, Rochester, MN, USA
Fahimeh Talaei
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
Stephanie Welle
Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
Jamil Taji
Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
Sandeep Khosa
Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
Nikhil Sharma
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Meghan Brown
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Amos Lal
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Vikas Bansal
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Syed Anjum Khan
Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
Abigail T. La Nou
Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
Devang Sanghavi
Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
Rodrigo Cartin-Ceba
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
Rahul Kashyap
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; Department of Research, WellSpan Health, York, PA, USA
Ognjen Gajic
Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
Juan P. Domecq
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
Natalya Azadeh
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA; Corresponding author. Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, 13400 E. Shea Blvd. Scottsdale, AZ, 85259, USA.
Objective: To describe the characteristics of COVID-19 patients with pneumothorax and pneumomediastinum (PTX/PM) and their association with patient outcomes. Patients and methods: Adults admitted to five Mayo Clinic hospitals with COVID-19 between 03/2020–01/2022 were evaluated. PTX/PM was defined by imaging. Descriptive analyses and a matched (age, sex, admission month, COVID-19 severity) cohort comparison was performed. Hospital mortality, length of stay (LOS), and predisposing factors were assessed. Results: Among 6663 patients, 197 had PTX/PM (3 %) (75 PM, 40 PTX, 82 both). The median age was 59, with 71 % males. Exposure to invasive and non-invasive mechanical ventilation and high-flow nasal cannula before PTX/PM were 42 %, 17 %, and 20 %, respectively. Among isolated PTX and PM/PTX patients 70 % and 53.7 % underwent an intervention, respectively, while 96 % of the PM-only group was followed conservatively.A total of 171 patients with PTX/PM were compared to 171 matched controls. PTX/PM patients had more underlying lung disease (40.9 vs. 23.4 %, p < 0.001) and lower median body mass index (BMI) (29.5 vs. 31.3 kg/m2, p = .007) than controls. Among patients with available data, PTX/PM patients had higher median positive end-expiratory and plateau pressures than controls; however, differences were not significant (10 vs. 8 cmH2O; p = 0.38 and 28 vs. 22 cmH2O; p = 0.11, respectively). PTX/PM patients had a higher odds of mortality (adjusted odds ratio [95%CI]: 3.37 [1.61–7.07]) and longer mean LOS (percent change [95%CI]: 39 [9–77]) than controls. Conclusion: In COVID-19 patients with similar severity, PTX/PM patients had more underlying lung disease and lower BMI. They had significantly increased mortality and LOS.
