Characteristics and outcome of pneumothorax, pneumomediastinum, and subcutaneous emphysema in COVID-19 patients

Background: Pneumothorax, pneumomediastinum, and subcutaneous emphysema are few of fatal complications noted in patients with COVID-19 pneumonia. Various studies have shown prevalence of pneumothorax ranging between 1% and 2% in COVID-19 pneumonia. Materials and methods: A total of 10 inpatients admitted with COVID-19 disease confirmed by RT-PCR test who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema during hospital stay by sequential sampling method were included in the study. Demographic data, duration of hospital stay, underlying comorbidities, predisposing factors, radiographic characteristics, and mode of oxygen delivery were collected and analyzed. Results: In our study, mean age group of patient who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema was 39.8 years. Male to female ratio was 9:1. Mean time duration of onset of pneumothorax, pneumomediastinum, and subcutaneous emphysema from the day of hospitalization was 17.3 (8–30) days. Nine patients were on NIV (non-invasive ventilation) while one patient was on NRBM. Right sided involvement was noted in five patients, three had left sided involvement, and two patients had bilateral pneumothorax. Five patients had pneumomediastinum and subcutaneous emphysema along with pneumothorax. All patients received antivirals (Inj. Remdesivir), systemic steroids along with other supportive treatment. Except for one patient, all patients who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema succumbed. All patients’ chest radiograph was consistent with COVID-19 pneumonia. One patient had pulmonary cyst on Computerized Tomography (CT) thorax which was done post intercostal drainage of pneumothorax. Mean time of death after development of pneumothorax, pneumomediastinum, subcutaneous emphysema was 4.3 days. Comorbidities observed were bronchial asthma, obesity, and status post Caesarian section. Conclusion: Development of pulmonary barotrauma in COVID-19 patients is associated with high mortality. Presence of pulmonary cyst, prexisting bronchial asthma, obesity, systemic steroids are possible poor determinants.