Pneumothorax in Non-ventilated Patients with COVID-19 Pneumonia: Management and Outcome of a Rare Entity | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 60, Volume 98, Issue 1, January 2025, Page 412-421 PDF (614.88 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2025.406034 | ||||
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| Abstract | ||||
| Background: Rapid clinical deterioration of patients with COVID-19 pneumonia has three potential causes including: Disease progression, pulmonary embolism, and pneumothorax. Pneumothorax is a serious complication in patients with parenchymal lung disease, which may require rapid intervention. Objective: This study aimed to review management and outcome of spontaneous pneumothorax in our hospitalized non-ventilated patients with COVID-19 pneumonia, and to evaluate the relation of pneumothorax with in-hospital outcome. Patients and methods: This retrospective study included non-ventilated patients who had spontaneous pneumothorax associated with moderate or severe COVID-19 pneumonia. Pneumothorax was managed considering hemodynamics and size of pneumothorax. When indicated, tube thoracostomy was performed under strict protective measures. Results: There were 12 cases of spontaneous pneumothorax out of 136 initially non-ventilated COVID-19 patients (8.82%), with median age of 62.5 years. The imaging features included unilateral pneumothorax (91.7%), bilateral pneumothorax (8.3%), subcutaneous emphysema (41.7%), tension pneumothorax (16.7%), pneumomediastinum (16.7%), and hydropneumothorax (8.3%). After median hospital stay of 13 days, the recovery rate was 41.7%, while death was reported in 58.3%. Treatment of pneumothorax was conservative in 58.3% and tube thoracostomy in 41.7% with median chest tube duration of 4 days. Pneumothorax resolved in all patients with no need for further surgical intervention. In comparison with survivors, died patients had higher frequency of severe pneumonia (P= 0.02) and higher ferritin levels (P= 0.04). Severe pneumonia at presentation and the need for invasive ventilation later on had significant impacts on survival after presentation of pneumothorax (P-values of Log Rank test = 0.011 and 0.027 respectively). Conclusion: Pneumothorax is a rare but serious complication of COVID-19, which requires early diagnosis and treatment. Presentation with severe pneumonia and later on deterioration affected prognosis of initially non-ventilated COVID-19 patients with spontaneous pneumothorax. | ||||
| Keywords | ||||
| Coronavirus; COVID-19; Pneumothorax; Pneumomediastinum; Tube thoracostomy; Bullectomy | ||||
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