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Multicenter Study
. 2024 Aug-Sep:230:107684.
doi: 10.1016/j.rmed.2024.107684. Epub 2024 May 31.

Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study

Stefano Negri  1 , Emilia Mazzuca  2 , Filippo Lococo  3 , Michele Mondoni  4 , Marcello Covino  5 , Khrystyna Kuzmych  3 , Sergio Agati  1 , Marta Amata  2 , Giuseppe Arcoleo  2 , Luciano Gabbrielli  6 , Roberta Pancani  6 , Ersilia Tedeschi  7 , Pierpaolo Baiamonte  2 , Alessandro Sassu  8 , Filippo Patrucco  9 , Valentina Foci  10 , Giampietro Marchetti  11 , Federica Vernuccio  12 , Erika Zanardi  13 , Anna Talia Gaccione  14 , Claudio Sorino  15
Affiliations
Multicenter Study

Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study

Stefano Negri et al. Respir Med. 2024 Aug-Sep.

Abstract

Background: An increased incidence of pneumomediastinum has been observed among patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. The study aimed to identify risk factors for COVID-19-associated pneumomediastinum and investigate the impact of pneumomediastinum on clinical outcomes.

Methods: In this multicentre retrospective case-control study, we included consecutive patients with COVID-19 pneumonia and pneumomediastinum hospitalized from March 2020 to July 2020 at ten centres; then, we identified a similarly sized control group of consecutive patients hospitalized with COVID-19 pneumonia and respiratory failure who did not develop pneumomediastinum during the same period. Clinical, laboratory, and radiological characteristics, as well as respiratory support and outcomes, were collected and compared between the two groups. Risk factors of pneumomediastinum were assessed by multivariable logistic analysis.

Results: Overall 139 patients with pneumomediastinum and 153 without pneumomediastinum were analysed. Lung involvement ≥75 %, consolidations, body mass index (BMI) < 22 kg/m2, C-reactive protein (CRP) > 150 mg/L, D-dimer >3000 ng/mL FEUs, and smoking exposure >20 pack-year were all independently correlated with the occurrence of pneumomediastinum. Patients with pneumomediastinum had a longer hospital stay (mean ± SD 31.2 ± 20.2 days vs 19.6 ± 14.2, p < 0.001), higher intubation rate (73/139, 52.5 % vs 27/153, 17.6 %, p < 0.001), and in-hospital mortality (68/139, 48.9 % vs 36/153, 23.5 %, p < 0.001) compared to controls.

Conclusions: Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with a greater risk of pneumomediastinum in COVID-19 pneumonia. This complication significantly worsens the outcomes.

Keywords: ARDS & mechanical ventilation; COVID-19; Pneumomediastinum; Pulmonary barotrauma; SARS-CoV-2; Subcutaneous emphysema.

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Conflict of interest statement

Declaration of competing interest All authors have no conflict of interest to disclose.

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