PT  - JOURNAL ARTICLE
AU  - Akshay Dwarakanath
AU  - Laura Horgan
AU  - Manika Jayawardena
AU  - Muthu Thirumaran
AU  - Owen Johnson
TI  - The clinical course of pneumomediastinum in patients with SARS-CoV-2 before invasive mechanical ventilation
AID  - 10.7861/clinmed.2021-0441
DP  - 2022 May 01
TA  - Clinical Medicine
PG  - 271--275
VI  - 22
IP  - 3
4099  - http://www.rcpjournals.org/content/22/3/271.short
4100  - http://www.rcpjournals.org/content/22/3/271.full
SO  - Clin Med2022 May 01; 22
AB  - Pneumomediastinum and pneumothorax are recognised complications encountered in COVID-19 before or during invasive mechanical ventilation (IMV). The clinical course of patients developing pneumomediastinum before IMV is yet to be evaluated.Four-thousand, one-hundred and thirty-one patients hospitalised with COVID-19 over a 12-month period were retrospectively reviewed to evaluate for incidence, clinical characteristics and outcomes. A subgroup analysis was done to identify any clinical traits between survivors and non-survivors. The overall incidence of pneumomediastinum prior to IMV was 0.92% (n=38) and was seen at admission or during non-invasive respiratory support. Thirty-seven per cent had associated pneumothorax most commonly unilateral (right side). The median (interquartile range (IQR)) duration from admission to developing pneumomediastinum was 7 days (3–11) and complete resolution was seen in 53% of patients; median (IQR) duration to resolution was 8 days (4–17). The in-hospital mortality associated with pneumomediastinum in patients with SARS-CoV-2 (PneumoCoV) was 55%. Increasing age (68 ± 12 years vs 56 ± 14 years; p=0.01), higher body mass index (31 ± 5 kg/m2 vs 28 ± 5 kg/m2; p=0.04), lack of resolution of pneumomediastinum (67% vs 24%; p=0.01; odds ratio (OR) 6.5; 95% confidence interval (CI) 1.5–27.5), presence of concurrent pneumothorax (65% vs 14%; p=0.002; OR 11; 95% CI 2.2–53.1) and elevated procalcitonin levels (>0.5 ng/mL; 81% vs 41%; p=0.01; OR 6; 95% CI 1.4–26) were significant features in those who did not survive.The incidence of PneumoCoV, despite being low, is associated with increased mortality. It is a hallmark of moderate to severe disease with multifaceted contributory factors. Both demographic and clinical factors predict survival.