Subcutaneous emphysema, pneumomediastinum and pneumothorax in COVID-19 pneumonia-independent prognostic factors

The ongoing coronavirus disease 2019 pandemic has created a substantial disease burden and morbidity. However, the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax have been of rare occurrence and their significance in mortality has not been studied. In a retrospective single-institution observational study at a tertiary care centre in the northern part of India, we evaluated the occurrence of these complications and their relationship with mortality from 1 June 2020 to 30 November 2020. All coronavirus disease 2019 (COVID-19) patients developing subcutaneous emphysema, pneumomediastinum, and pneumothorax were included. Cardiopulmonary resuscitation-induced complications were excluded. Measured endpoints were either discharge to home or death. There were 3145 COVID-19 patients admitted during the study period. Altogether, 38 patients developed one of these complications or in combination. There were 33 male and 5 female patients with an age range from 23 to 95 years, mean 57 & PLUSMN; 12.7. 36 of 38 patients developed these complications while on the ventilator and required chest drain insertions as a part of management. Two patients developed these complications while breathing spontaneously. The incidence of these complications among ventilated patients was 22.9% (36/157). 32 of 38 died giving a mortality of 84.21%. The average time from the development of these complications to death was 8.4 days (range 2-27 days). We conclude that lung changes in COVID-19 patients make them prone to the development of air leaks. Subcutaneous emphysema, pneumomediastinum, and pneumothorax were more common in ventilated patients but were also observed in spontaneously breathing patients. These complications were associated with significantly high mortality in COVID-19 patients (p-value = 0.0002 by Chi-square test).