A case series of pneumothorax, pneumomediastinum and surgical emphysema in coronavirus disease 2019 (COVID-19)

Background: The coronavirus disease 2019 (COVID-19) pandemic has been ongoing for nearly 18 months now and whilst randomized trials identify appropriate treatments, observational data increases knowledge around the real-life effects of COVID-19. Air leak in the context of acute lung injury is not a new phenomenon and usually associated with ventilation-induced lung injury. Air leaks (pneumothorax and pneumomediastinum) in the context of COVID-19 are being increasingly described. We sought to add to the literature by performing a local case review. Methods: Northumbria Healthcare NHS Trust serves a population of approximately 600,000 in the North East of the United Kingdom. The records of all COVID-19 inpatients between March 2020 till January 2021 were analyzed. Local Caldicott approval was granted. Basic demographics and outcomes were collected. Descriptive statistical methodology was applied. Results: Thirty-two air leaks were identified out of 2,827 inpatients, giving an incidence of 1.1%. The patients were predominantly male, elderly and with a higher-than-normal body mass index (BMI). There was no relation to previous respiratory disease and ventilation. Air leaks occurred late, signifying progressive lung injury. Fifteen deaths occurred in this specific cohort. Conclusions: Air leaks are rare but carry significant morbidity and mortality. Knowledge of this evidence can thus enable patient centered decisions about prognostication. Analysis of large data sets will shed further light on this association.