Incidence of pneumomediastinum in COVID-19: A single-center comparison between 1st and 2nd wave

Abstract

In this study, we compared the incidence of pneumomediastinum in coronavirus disease (COVID-19) patients during the ascending phases of the 1st and 2nd epidemic waves. Crude incidence was higher during the 2nd wave at a quasi-significant level (0.68/1000 vs. 2.05/1000 patient-days, p = 0.05). When restricting the analysis to patients who developed pneumomediastinum during noninvasive ventilation, the difference became clearly significant (0.17/1000 vs 1.36/1000 patient-days, p = 0.039). At logistic regression, predisposing factors (p = 0.031), and COVID-19 radiological severity (p = 0.019) were independently associated with pneumomediastinum. Mortality in patients with pneumomediastinum was 87.5%. However, pneumomediastinum seemed to be related to a generally worse disease presentation in hospitalized patients during the 2nd wave, rather than to a separate pattern of disease.

Keywords: Barotrauma; COVID-19; Pneumomediastinum; Pneumothorax.

Fig. 1

Cumulative daily hospitalizations during 1st and 2nd COVID-19 epidemic waves at the Tor Vergata Polyclinic of Rome, Italy.

Fig. 2

Kaplan-Meier analysis of cumulative survival proportion during 1st (blue line) and 2nd epidemic wave (green line). The dashed vertical line indicates the mean hospital stay (22 days). Day intervals: 1–10, 11–20, 21–30, 31–40. Number of patients entering each interval (1st wave): 286, 204, 106, 65; number of patients entering each interval (2nd wave): 400, 230, 106, 47; number censored per interval (1st wave): 42, 63, 30, 56); number censored per interval (2nd wave): 115, 83, 43, 27; deaths per interval (1st wave): 40, 35, 11, 1; deaths per interval (2nd wave): 55, 41, 16, 11. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)