Pneumothorax as a Complication of COVID-19

Abstract

Since the coronavirus disease-2019 (COVID-19) outbreak in December 2019, evidence suggests an association between COVID-19 and the onset of pneumothorax (PTX). Thus, the present study aimed to investigate the onset of PTX, the possible risk factors, clinical characteristics, management, prognosis, and mechanism of PTX formation in patients with COVID-19 infection. A systematic review was done using several databases for articles published from December 2019 to January 2021. One-hundred and thirty-nine patients in a total of 87 articles fulfilled our criteria. A broad age range was affected (mean and standard deviation of 57 ± 15.39) with male predominance (77.7%). Most patients (66.2%) developed PTX during the hospital stays. In those who developed PTX, the most recognized characteristics included male gender (77.7%), severe COVID-19 infection (41%), mechanical ventilation (43.2%), age >65 years (30.9%), other diseases (79.1%), and smoking (8.6%). A good prognosis was reported in more than half of the patients (83; 59.7%). Death was significantly associated with critical conditions of COVID-19, bilateral PTX, respiratory distress, and mechanical ventilation (P = 0.006, 0.001, 0.013, and 0.001, respectively). PTX is a potential complication of COVID-19 infections, commonly noticed in the right lung. Mechanical ventilation, COVID-19 severity, bilateral PTX, and acute respiratory distress were associated with worse outcomes in COVID-19 patients with PTX.