Patient self-inflicted lung injury associated pneumothorax/pneumomediastinum is a risk factor for worse outcomes of severe COVID-19: a case-control study

Abstract

Abstract Purpose We aimed to determine the clinical characteristics of patient self-inflicted lung injury (P-SILI)-associated pneumothorax/pneumomediastinum, explore its risk factors, and measure its impact on severe COVID-19 cases.Methods In total, 229 patients were included in this case-control study. They were divided into the case group and control group according to the inclusion criteria. Then, the two groups were compared to explore the risk factors of spontaneous pneumothorax/pneumomediastinum. Finally, we analyzed the risk factors of death in the case group and among all patients.Results The mean age of patients was 59.69 ± 17.01 years, most of them were male (74.2%), and 62.0% of them had comorbidities on admission. A respiratory rate higher than 30 was a risk factor for spontaneous pneumothorax/pneumomediastinum (OR = 7.186, 95% CI 2.414–21.391, P < 0.001). Patients with delayed intubation due to early application of HFNC or NIV had a higher mortality rate when they were complicated with spontaneous pneumothorax/pneumomediastinum (p < 0.05). Additionally, advanced age increased the risk of death (p < 0.05). Finally, spontaneous pneumothorax/pneumomediastinum may be a risk factor for death among patients with severe COVID-19 (OR 2.047).Conclusion P-SILI occurs in severe COVID-19 with acute respiratory failure. It is necessary to identify the risk factors of P-SILI, the indicators of severe P-SILI, and the preventive measures.