Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey. Issue 3 (1st September 2022)

• Record Type: Journal Article
• Authors: Melhorn, James; Achaiah, Andrew; Conway, Francesca M.; Thompson, Elizabeth M.F.; Skyllberg, Erik W.; Durrant, Joseph; 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, Avinash; Jackson, Karl A.; Iftikhar, Hina; Noble, Jonathan H.; Ng, Anthony Y.K.C.; Nugent, Mark; Evans, Philip J.; Hastings, Robert A.; Bellenberg, Harry R.; Lawrence, Hannah; Saville, Rachel L.; Johl, Nikolas T.; Grey, Adam N.; Ellis, Huw C.; Chen, Cheng; Jones, Thomas L.; Maddekar, Nadeem; Khan, Shahul Leyakathali; Muhammad, Ambreen Iqbal; Ghani, Hakim; Maung Maung Myint, Yadee; Rafique, Cecillia; Pippard, Benjamin J.; Irving, Benjamin R.H.; Ali, Fawad; Asimba, Viola H.; Azam, Aqeem; 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, Beatriz; Mahdi, Noor A.; Morgan, Caitlin; Patel, Neena; Rowlands, Elen W.; Steward, Matthew S.; Thorley, Richard S.; Wollerton, Rebecca L.; Ullah, Sana; Smith, David M.; Lason, Wojciech; Rostron, Anthony J.; Rahman, Najib M.; Hallifax, Rob J.;
• Is Part Of: European respiratory journal. Volume 60:Issue 3(2022)
• Publication Date: 2022-09-01
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.02522-2021
• Languages: English
• ISSNs: 0903-1936

Abstract

Background: There 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. Methods: A structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicited via respiratory 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. Results: 377 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. Conclusions: PTM 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. Roughly 0.6% of patients admitted with COVID-19 have pneumomediastinum identified. The finding is associated with severe COVID-19 and high mortality. https://bit.ly/3nXlaR5