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. 2021 Aug:184:106464.
doi: 10.1016/j.rmed.2021.106464. Epub 2021 May 13.

Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study

Amit Chopra  1 , Ali Hani Al-Tarbsheh  2 , Nidhi J Shah  3 , Hamid Yaqoob  4 , Kurt Hu  5 , Paul J Feustel  6 , Ronaldo Ortiz-Pacheco  7 , Kinner M Patel  7 , Jozef Oweis  2 , Natalya Kozlova  4 , Spyridon Zouridis  2 , Sahar Ahmad  7 , Oleg Epelbaum  4 , Woon H Chong  8 , John T Huggins  9 , Biplab K Saha  10 , Edward Conuel  2 , Hau Chieng  2 , Jeannette Mullins  8 , Divyansh Bajaj  5 , Boris Shkolnik  8 , Rachel Vancavage  11 , Nagendra Madisi  8 , Marc A Judson  8
Affiliations

Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study

Amit Chopra et al. Respir Med. 2021 Aug.

Abstract

Background: The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax has not been rigorously described or compared to those who do not develop a pneumothorax.

Purpose: To determine the incidence, clinical characteristics, and outcomes of critically ill patients with COVID-19 infection who developed pneumothorax. In addition, we compared the clinical characteristics and outcomes of mechanically ventilated patients who developed a pneumothorax with those who did not develop a pneumothorax.

Methods: This study was a multicenter retrospective analysis of all adult critically ill patients with COVID-19 infection who were admitted to intensive care units in 4 tertiary care centers in the United States.

Results: A total of 842 critically ill patients with COVID-19 infection were analyzed, out of which 594 (71%) were mechanically ventilated. The overall incidence of pneumothorax was 85/842 (10%), and 80/594 (13%) in those who were mechanically ventilated. As compared to mechanically ventilated patients in the non-pneumothorax group, mechanically ventilated patients in the pneumothorax group had worse respiratory parameters at the time of intubation (mean PaO2:FiO2 ratio 105 vs 150, P<0.001 and static respiratory system compliance: 30ml/cmH2O vs 39ml/cmH2O, P = 0.01) and significantly higher in-hospital mortality (63% vs 49%, P = 0.04).

Conclusion: The overall incidence of pneumothorax in mechanically ventilated patients with COVID-19 infection was 13%. Mechanically ventilated patients with COVID-19 infection who developed pneumothorax had worse gas exchange and respiratory mechanics at the time of intubation and had a higher mortality compared to those who did not develop pneumothorax.

Keywords: 2; Barotrauma; COVID-19; Coronavirus disease 2019; Incidence; Mortality; Pneumomediastinum; Pneumothorax; SARS-CoV-2.

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Conflict of interest statement

MAJ: received institution grant support from Mallinckrodt pharmaceuticals. JH: Consultant/Advisory Boards: IBIOS [IPF]; Roche/Genentech [IPF (Nintedanib)]; Boehringer Ingelheim [IPF (Pirfenidone)]. PJF: Scientific advisor with shares in Penrose TherapeuTx, LLC. The remaining authors have no disclosures or any potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meir Survival curve of in-hospital survival of patients with COVID-19 infection. In this analysis, we assumed that those patients who were discharged were alive at 120 days after the hospital admission. Red dotted curve shows in-hospital survival of patients with pneumothorax and blue curve represent in-hospital survival of patients without pneumothorax. Survival curves are not statistically different (log rank test; P = 0.55), although survival at 120 days was statistically higher in non-pneumothorax group as compared to pneumothorax group (chi-square test; p = 0.04). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
a-2c Comparison of ventilator, ICU, and hospital free days at day 28. Dots are individual patients and crosses are the means. Medians are zero for both pneumothorax and non-pneumothorax group. Ventilator (2a), ICU (2b) and hospital (2c) free days at day 28, are higher for those without a pneumothorax as compared to those with pneumothorax (Mann Whitney test; p<0.001).
Fig. 3
Fig. 3
Whisker plot comparing the respiratory parameters (Ventilator parameters-3a and blood gas values -3b) of pneumothorax and non-pneumothorax at the time of intubation. Grey shaded rectangular box is the interquartile range (IQR, the 25th to the 75th percentile), the horizontal line within the box is the median, the solid square symbol is the mean.
Fig. 4
Fig. 4
Whisker plot comparing the laboratory values of pneumothorax and non-pneumothorax at the time of admission. Grey shaded rectangular box is the interquartile range (IQR, the 25th to the 75th percentile), the horizontal line within the box is the median, the solid square symbol is the mean.
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