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Marza AM, Cindrea AC, Petrica A, Stanciugelu AV, Barsac C, Mocanu A, Critu R, Botea MO, Trebuian CI, Lungeanu D. Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with COVID-19: Three-Year Debriefing across Five Pandemic Waves. J Pers Med 2023; 13:1497. [PMID: 37888108 PMCID: PMC10608223 DOI: 10.3390/jpm13101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Spontaneous pneumothorax and pneumomediastinum (SP-SPM) are relatively rare medical conditions that can occur with or independently of COVID-19. We conducted a retrospective analysis of SP-SPM cases presented to the emergency departments (EDs) of two University-affiliated tertiary hospitals from 1 March 2020 to 31 October 2022. A total of 190 patients were identified: 52 were COVID-19 cases, and 138 were non-COVID-19 cases. The primary outcome we were looking for was in-hospital mortality. The secondary outcomes concerned the disease severity assessed by (a) days of hospitalization; (b) required mechanical ventilation (MV); and (c) required intensive care (IC). All were investigated in the context of the five pandemic waves and the patients' age and comorbidities. The pandemic waves had no significant effect on the outcomes of these patients. Logistic regression found age (OR = 1.043; 95%CI 1.002-1.085), COVID-19 (OR = 6.032; 95%CI 1.757-20.712), number of comorbidities (OR = 1.772; 95%CI 1.046-3.001), and ground-glass opacities over 50% (OR = 5.694; 95%CI 1.169-27.746) as significant risk predictors of in-hospital death while controlling for gender, smoking, the pandemic wave, and the extension of SP-SPM. The model proved good prediction performance (Nagelkerke R-square = 0.524) and would hold the same significant predictors for MV and IC.
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Affiliation(s)
- Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.M.); (A.P.); (C.I.T.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | | | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.M.); (A.P.); (C.I.T.)
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Alexandra Valentina Stanciugelu
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Claudiu Barsac
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.M.); (A.P.); (C.I.T.)
- Clinic of Anaesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Alexandra Mocanu
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Roxana Critu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihai Octavian Botea
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Cosmin Iosif Trebuian
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.M.); (A.P.); (C.I.T.)
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Woo W, Kipkorir V, Marza AM, Hamouri S, Albawaih O, Dhali A, Kim W, Udwadia ZF, Nashwan AJ, Shaikh N, Belletti A, Landoni G, Palumbo D, Swed S, Sawaf B, Buonsenso D, Pimenta I, Gonzalez FA, Fiorentino G, Rashid Ali MRS, Quincho-Lopez A, Javanbakht M, Alhakeem A, Khan MM, Shah S, Rafiee MJ, Padala SRAN, Diebel S, Song SH, Kang DY, Moon DH, Lee HS, Yang J, Flower L, Yon DK, Lee SW, Shin JI, Lee S. Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score. J Clin Med 2022; 11:7132. [PMID: 36498706 PMCID: PMC9739102 DOI: 10.3390/jcm11237132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.
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Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Vincent Kipkorir
- Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi 00100, Kenya
| | - Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Shadi Hamouri
- Department of General Surgery & Urology, King Abdullah University Hospital, Jordan University of Science & Technology, Irbid 22110, Jordan
- Department of General Surgery and Special Surgery, Faculty of Medicine, Al- Balqa’ Applied University, Al-Salt 19117, Jordan
| | - Omar Albawaih
- Department of General Surgery & Urology, King Abdullah University Hospital, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Arkadeep Dhali
- Institute of Postgraduate Medical Education and Research, Kolkata 700020, India
| | - Wooshik Kim
- Department of Thoracic and Cardiovascular Surgery, National Medical Center, Seoul 04564, Republic of Korea
| | | | - Abdulqadir J. Nashwan
- Critical Care Department, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha 576214, Qatar
| | - Nissar Shaikh
- Surgical Intensive Care Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha 576214, Qatar
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo 15310, Syria
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad General Hospital, Doha 576214, Qatar
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
| | - Inês Pimenta
- Intensive Care Department, Hospital Garcia de Orta EPE, 2805-267 Almada, Portugal
| | | | - Giuseppe Fiorentino
- Sub-Intensive Care Unit and Respiratory Physiopathology Department, Cotugno-Monaldi Hospital, 80131 Naples, Italy
| | | | - Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran
| | | | | | - Sangam Shah
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu 44618, Nepal
| | - Moezedin Javad Rafiee
- Babak Imaging Center, Tehran 1415943953, Iran
- McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | | | - Sebastian Diebel
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Seung Hwan Song
- Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
| | - Du-young Kang
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03063, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Luke Flower
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Gulati U, Medeiros C, Nanduri A, Kanoff J, Zarbiv S, Bonk M, Green A. Understanding Pneumomediastinum as a Complication in Patients With COVID-19: A Case Series. J Investig Med High Impact Case Rep 2022; 10:23247096221127117. [PMID: 36125171 PMCID: PMC9490390 DOI: 10.1177/23247096221127117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
Pneumomediastinum is a rare complication among non-coronavirus patients but has been published with increased incidence in patients positive for SARS-CoV-2 infection. Most of these studies report patients on mechanical ventilation and an understanding of mechanisms causing this remains limited. We aim to use an increasing occurrence in patients not on mechanical ventilation to further explore mechanisms that predispose patients to pneumomediastinum and to assess characteristics potentially related to poor outcomes. We report a case series of 37 patients diagnosed with COVID-19 and pneumomediastinum at a 2-hospital institution between January 1, 2020 and April 30, 2021. At 28 days after diagnosis of pneumomediastinum, 19 (51.4%) were dead and mortality was significantly higher among those who were older (t = 2.147, P = .039), female (χ2 = 10.431, P = .015), body mass index ≥30 (χ2 = 6.0598, P = .01), intubated (χ2 = 4.937, P = .026), and had pre-existing lung disease (χ2 = 4.081, P = .043). Twenty-three patients (62.2%) were identified to have pneumomediastinum without receiving invasive mechanical ventilation, of which 11 (47.8%) were diagnosed without receiving noninvasive ventilation. The increased diagnosis of pneumomediastinum in patients with COVID-19 while not on mechanical ventilation, in this case series and in comparable studies, may attribute to mechanisms aside from positive pressure ventilation such as patient self-induced lung injury and pulmonary frailty.
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Affiliation(s)
| | | | | | | | | | | | - Adam Green
- Cooper University Health Care, Camden, NJ, USA
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