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. 2021 Sep-Oct;50(5):599-608.
doi: 10.1016/j.hrtlng.2021.04.005. Epub 2021 May 1.

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

Woon H Chong  1 , Biplab K Saha  2 , Kurt Hu  3 , Amit Chopra  4
Affiliations

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review

Woon H Chong et al. Heart Lung. 2021 Sep-Oct.

Abstract

Background: Pneumothorax has been frequently described as a complication of COVID-19 infections.

Objective: In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax.

Methods: Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of "COVID-19," "SARS-CoV-2," "pneumothorax," "pneumomediastinum," and "barotrauma" from January 1st, 2020 to January 30th, 2021.

Results: Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8-23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0-19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly.

Conclusion: COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.

Keywords: COVID-19; SARS-CoV-2; barotrauma; pneumomediastinum; pneumothoraces; pneumothorax.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1:
Fig. 1
Flowchart for studies selected in review of COVID-19 patients with pneumothorax.
See this image and copyright information in PMC

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