Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation. Issue 3 (23rd March 2021)

• Record Type: Journal Article
• Authors: Thein, Onn Shaun; Niazi, Muhammad; Ali, Abdisamad; Sahal, Adeel
• Is Part Of: BMJ case reports. Volume 14:Issue 3(2021)
• Publication Date: 2021-03-23
• Subjects: pneumonia (infectious disease) -- pneumonia (respiratory medicine) -- COVID-19 -- CPAP; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-241809
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19. Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later. We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.