Spontaneous Pneumomediastinum: Clinical Presentation and Outcome in COVID-19 Patients

Javed Mirdad Tarar; Kashif  Nadeem; Durre Sadaf Sadaf Khan; Muhammad  Rashid

doi:10.29054/apmc/2022.1375

Javed Mirdad Tarar Consultant Thoracic Surgeon, Aseer Central Hospital, Abha Kingdome of Saudi Arabia
Kashif Nadeem Consultant General Surgeon, Prince Mansoor Military Hospital, Taif Kingdome of Saudi Arabia
Durre Sadaf Sadaf Khan Post Graduate Resident, Department of Hematology, Combined Military Hospital, Multan Pakistan
Muhammad Rashid Consultant Thoracic Surgeon, Armed Forces Hospital, Al-Hada, Taif Kingdome of Saudi Arabia

DOI: https://doi.org/10.29054/apmc/2022.1375

Keywords: Pneumomediastinum: PM,, Mechanical ventilation: MV, Pneumothorax: PTX,, Corona Virus Disease 2019: COVID-19

Abstract

Background: The novel corona virus disease has become the largest global pandemic of this century. Spontaneous Pneumomediastinum is one of the manifestations of COVID-19 patients. The association between PM and COVID-19 is neither well understood nor well studied. Therefore, we decided to conduct a study on COVID-19 patients who developed PM in our institution to elaborate its clinical aspects and outcome. Objective: The objective of the study was to establish the association of PM with COVID-19 and to determine its incidence, clinical manifestations and mortality rate. Study Design: Retrospective review. Settings: Aseer Central Hospital, Kingdom of Saudi Arabia. Duration: Eleven months from March 2020 to December 2020. Methods: All PCR confirmed COVID-19 patients admitted in our hospital who developed PM were included in our study. Retrospective analysis out their medical records and radiological review was carried out for all such patients. Data of clinical features, associated comorbidities and outcome was collected and descriptive analysis was made. Results: A total of 856 patients were admitted with PCR positive results for COVID-19. Out of these, 86(10%) pts developed PM. 93% pts required mechanical ventilation, whereas 7% of pts were spontaneously breathing with high flow nasal cannula oxygen therapy. 61(71%) pts developed concurrent pneumothorax. 58(67.4%) of pts required tube thoracostomy. Overall mortality was 70%(n=60), mainly in the subgroup of mechanically ventilated patients. Conclusion: Pneumomediastinum, a rarely seen phenomenon generally, is more frequently encountered in COVID-19 patients. The mortality rate is significantly higher in such patients who require artificial ventilation and have underlying medical comorbidities.