Addenbrooke's Hospital, Cambridge, UK.
CITIID, University of Cambridge, Cambridge, UK.
Eur Respir J. 2020 Nov 19;56(5). doi: 10.1183/13993003.02697-2020. Print 2020 Nov.
Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients).
Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival.
71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5±7.7% females 68.4±10.7%; p=0.619). Patients aged ≥70 years had a significantly lower 28-day survival than younger individuals (≥70 years 41.7±13.5% survival <70 years 70.9±6.8% survival; p=0.018 log-rank).
These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.
气胸和纵隔气肿均已被报道为合并需要住院治疗的 2019 年冠状病毒病（COVID-19）病例的并发症。我们报告了迄今为止最大的一组同时存在这两种病理的患者病例系列（包括未通气的患者）。
从英国的医院中回顾性收集病例，纳入标准仅限于 COVID-19 的诊断和气胸或纵隔气肿的存在。纳入研究的患者在 2020 年 3 月至 6 月之间出现。从病历中获得的详细信息包括人口统计学、影像学、实验室检查、临床管理和生存情况。
16 个中心的 71 名患者纳入研究，其中 60 名患有气胸（6 名合并纵隔气肿），11 名患有纵隔气肿。其中两名患者有两次不同的气胸发作，呈双侧连续顺序发生，使纳入的气胸总数增加到 62 例。临床情况包括因气胸而到医院就诊的患者、在 COVID-19 住院期间发生气胸或纵隔气肿的患者以及在插管和通气期间发生并发症的患者，无论是否同时进行体外膜氧合。气胸后 28 天的生存率（63.1±6.5%）或孤立性纵隔气肿后 28 天的生存率（53.0±18.7%；p=0.854）无显著差异。男性气胸的发生率较高。28 天生存率在性别之间无差异（男性 62.5±7.7% 女性 68.4±10.7%；p=0.619）。≥70 岁的患者 28 天生存率明显低于年轻患者（≥70 岁 41.7±13.5%生存率 ＜70 岁 70.9±6.8%生存率；p=0.018 对数秩检验）。
这些病例表明气胸是 COVID-19 的一种并发症。气胸似乎不是预后不良的独立标志物，我们鼓励在临床可能的情况下继续积极治疗。
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