Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey
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Published:2022-02-10
Issue:3
Volume:60
Page:2102522
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ISSN:0903-1936
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Container-title:European Respiratory Journal
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language:en
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Short-container-title:Eur Respir J
Author:
Melhorn JamesORCID, Achaiah AndrewORCID, Conway Francesca M., Thompson Elizabeth M.F., Skyllberg Erik W., Durrant JosephORCID, Hasan Neda A., Madani Yasser, Naran Prasheena, Vijayakumar Bavithra, Tate Matthew J., Trevelyan Gareth E., Zaki Irfan, Doig Catherine A., Lynch Geraldine, Warwick Gill, Aujayeb AvinashORCID, Jackson Karl A.ORCID, Iftikhar HinaORCID, Noble Jonathan H., Ng Anthony Y.K.C., Nugent Mark, Evans Philip J., Hastings Robert A.ORCID, Bellenberg Harry R., Lawrence Hannah, Saville Rachel L., Johl Nikolas T., Grey Adam N., Ellis Huw C.ORCID, Chen Cheng, Jones Thomas L.ORCID, Maddekar Nadeem, Khan Shahul Leyakathali, Muhammad Ambreen Iqbal, Ghani Hakim, Maung Maung Myint Yadee, Rafique Cecillia, Pippard Benjamin J., Irving Benjamin R.H.ORCID, Ali Fawad, Asimba Viola H., Azam AqeemORCID, Barton Eleanor C., Bhatnagar Malvika, Blackburn Matthew P., Millington Kate J., Budhram Nicholas J., Bunclark Katherine L., Sapkal Toshit P., Dixon Giles, Harries Andrew J.E., Ijaz Mohammad, Karunanithi Vijayalakshmi, Naik Samir, Khan Malik Aamaz, Savlani Karishma, Kumar Vimal, Lara Gallego BeatrizORCID, Mahdi Noor A., Morgan Caitlin, Patel Neena, Rowlands Elen W., Steward Matthew S.ORCID, Thorley Richard S., Wollerton Rebecca L., Ullah Sana, Smith David M., Lason WojciechORCID, Rostron Anthony J.ORCID, Rahman Najib M.ORCID, Hallifax Rob J.
Abstract
BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome.MethodsA structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicitedviarespiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of PTM in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM at the time of diagnosis and thereafter (p<0.001), along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality.ConclusionsPTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.
Publisher
European Respiratory Society (ERS)
Subject
Pulmonary and Respiratory Medicine
Cited by
23 articles.
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