Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
Institute of Critical Care Medicine, Max Super Specialty Hospital, Saket, India.
Asian Cardiovasc Thorac Ann. 2022 Feb;30(2):237-244. doi: 10.1177/02184923211031134. Epub 2021 Jul 11.
There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes.
The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium).
A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006).
Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.
有各种关于 2019 年冠状病毒病（COVID-19）的空气泄漏报告。我们对所有已发表的病例报告和系列进行了系统回顾，以分析 COVID-19 中的空气泄漏类型及其结果。
从疫情开始到 2021 年 3 月 31 日，我们在 PubMed、Science Direct 和 Google Scholar 数据库中进行了文献检索。纳入标准为（1）实验室确诊的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染，（2）有个体患者详细信息，（3）报告诊断为一种或多种空气泄漏综合征（气胸、皮下气肿、纵隔气肿、气腹、心包积气）。
最终分析共纳入 105 项研究，共 188 例患者。中位年龄为 56.02（SD 15.53）岁，80%为男性，11%有既往呼吸系统疾病，8%为吸烟者。50.6%的患者患有严重或危急的 COVID-19。气胸（68%）是最常见的空气泄漏类型。大多数患者（56.7%）需要干预，死亡率较低（29.1%比 44.1%，p=0.07），肋间引流（95.9%）是首选的介入治疗。超过一半的患者在自主呼吸时发生空气泄漏。与正压通气（49%，p<0.001）和需要升级呼吸支持（39%，p=0.006）相关的空气泄漏患者死亡率明显更高。
COVID-19 中的空气泄漏可在无正压通气、更高的跨肺压和其他危险因素（如既往呼吸系统疾病或吸烟）的情况下自发发生。如果与正压通气和呼吸支持升级相关，死亡率显著更高。
