1
|
Chopra A, Al-Tarbsheh AH, Shah NJ, Yaqoob H, Hu K, Feustel PJ, Ortiz-Pacheco R, Patel KM, Oweis J, Kozlova N, Zouridis S, Ahmad S, Epelbaum O, Chong WH, Huggins JT, Saha BK, Conuel E, Chieng H, Mullins J, Bajaj D, Shkolnik B, Vancavage R, Madisi N, Judson MA. Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study. Respir Med 2021; 184:106464. [PMID: 34044224 PMCID: PMC8116127 DOI: 10.1016/j.rmed.2021.106464] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 12/18/2022]
Abstract
Background The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax has not been rigorously described or compared to those who do not develop a pneumothorax. Purpose To determine the incidence, clinical characteristics, and outcomes of critically ill patients with COVID-19 infection who developed pneumothorax. In addition, we compared the clinical characteristics and outcomes of mechanically ventilated patients who developed a pneumothorax with those who did not develop a pneumothorax. Methods This study was a multicenter retrospective analysis of all adult critically ill patients with COVID-19 infection who were admitted to intensive care units in 4 tertiary care centers in the United States. Results A total of 842 critically ill patients with COVID-19 infection were analyzed, out of which 594 (71%) were mechanically ventilated. The overall incidence of pneumothorax was 85/842 (10%), and 80/594 (13%) in those who were mechanically ventilated. As compared to mechanically ventilated patients in the non-pneumothorax group, mechanically ventilated patients in the pneumothorax group had worse respiratory parameters at the time of intubation (mean PaO2:FiO2 ratio 105 vs 150, P<0.001 and static respiratory system compliance: 30ml/cmH2O vs 39ml/cmH2O, P = 0.01) and significantly higher in-hospital mortality (63% vs 49%, P = 0.04). Conclusion The overall incidence of pneumothorax in mechanically ventilated patients with COVID-19 infection was 13%. Mechanically ventilated patients with COVID-19 infection who developed pneumothorax had worse gas exchange and respiratory mechanics at the time of intubation and had a higher mortality compared to those who did not develop pneumothorax.
Collapse
Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA.
| | | | - Nidhi J Shah
- Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - Hamid Yaqoob
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Kurt Hu
- Division of Pulmonary, Critical Care and Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, NY, USA
| | - Ronaldo Ortiz-Pacheco
- Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook Medicine, NY, USA
| | - Kinner M Patel
- Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook Medicine, NY, USA
| | - Jozef Oweis
- Department of Medicine, Albany Medical Center, NY, USA
| | - Natalya Kozlova
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | | | - Sahar Ahmad
- Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook Medicine, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Woon H Chong
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA
| | - John T Huggins
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA
| | - Edward Conuel
- Department of Medicine, Albany Medical Center, NY, USA
| | - Hau Chieng
- Department of Medicine, Albany Medical Center, NY, USA
| | - Jeannette Mullins
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA
| | - Divyansh Bajaj
- Division of Pulmonary, Critical Care and Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Boris Shkolnik
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA
| | - Rachel Vancavage
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA.
| | - Nagendra Madisi
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA
| |
Collapse
|