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Multicenter Study
. 2021 Nov;21(6):e615-e619.
doi: 10.7861/clinmed.2021-0220.

Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India

Zarir F Udwadia  1 , Kedar K Toraskar  2 , Lancelot Pinto  3 , Jai Mullerpatan  3 , Haresh D Wagh  3 , Joanne M Mascarenhas  4 , Bhavesh M Gandhi  4 , Awatansh Tripathi  3 , Ayesha Sunavala  3 , Umang Agrawal  3 , Viral Nanda  3 , Nikita Abraham  3 , Bony Francis  3 , Ravindra R Zore  2 , Gurudas Pundpal  2 , Bhoosan Gondse  2 , Gaurav A Gupta  2
Affiliations
Multicenter Study

Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India

Zarir F Udwadia et al. Clin Med (Lond). 2021 Nov.

Abstract

Background: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes.

Methods: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded.

Results: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001).

Conclusions: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.

Keywords: air leak in COVID-19; barotrauma in COVID-19; pneumomediastinum; pneumothorax.

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