Respiratory Medicine, 2153West Hertfordshire Hospitals NHS Trust England, Watford, UK *Joint first authors.
J Intensive Care Med. 2022 Aug;37(8):1015-1018. doi: 10.1177/08850666221091441. Epub 2022 Mar 31.
Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case series. The incidence is thought to be approximately 1% but is not definitively known.
To report the incidence and describe the demographic features, risk factors and outcomes of patients with air leak as a complication of COVID-19.
A retrospective observational study on all adult patients with COVID-19 admitted to Watford General Hospital, West Hertfordshire NHS Trust between March 1st 2020 and Feb 28 2021. Patients with air leak were identified after reviewing both chest radiographs (CXRs) and axial imaging (CT Thorax) with confirmatory radiology reports inclusive of the terms PTX and/or PM.
Air leak occurred with an incidence of 0.56%. Patients with air leak were younger and had evidence of more severe disease at presentation, including a higher median CRP and number of abnormal zones affected on chest radiograph. Asthma was a significant risk factor in the development of air leak (OR 13.4 [4.7-36.4]), both spontaneously and following positive pressure ventilation. CPAP and IMV were also associated with a greater than six fold increase in the risk of air leak (OR 6.4 [2.5-16.6] and 9.8 [3.7-27.8] respectively). PTX, with or without PM, in the context of COVID-19 pneumonia was almost universally fatal whereas those with alone PM had a lower risk of death.
Despite the global vaccination programme, patients continue to develop severe COVID-19 disease and may require respiratory support. This study demonstrates the importance of identifying that deterioration in such patients may be resultant from PTX or PM, particularly in asthmatics and those managed with positive pressure ventilation.
气胸（PTX）和纵隔气肿（PM），在这里统称为“空气泄漏”，在多个病例系列中被描述为严重 COVID-19 肺炎的常见并发症。据认为其发病率约为 1%，但尚未确定。
报告空气泄漏作为 COVID-19 并发症的发生率，并描述其患者的人口统计学特征、危险因素和结局。
这是一项对 2020 年 3 月 1 日至 2021 年 2 月 28 日期间在沃特福德综合医院、西赫特福德郡国民保健服务信托接受治疗的所有成年 COVID-19 患者进行的回顾性观察性研究。在回顾胸部 X 光片（CXR）和轴向成像（CT 胸部）并包含 PTX 和/或 PM 等放射学报告确认后，确定存在空气泄漏的患者。
空气泄漏的发生率为 0.56%。发生空气泄漏的患者年龄较小，且在就诊时表现出更严重的疾病，包括更高的中位 C 反应蛋白和胸部 X 光片上受影响的异常区域数量。哮喘是空气泄漏发展的显著危险因素（OR 13.4 [4.7-36.4]），无论是自发性还是在正压通气后。CPAP 和 IMV 也与空气泄漏风险增加六倍以上相关（OR 6.4 [2.5-16.6] 和 9.8 [3.7-27.8]）。在 COVID-19 肺炎的背景下，PTX 伴或不伴 PM 几乎都是致命的，而单独 PM 患者的死亡风险较低。
尽管全球疫苗接种计划仍在继续，但患者仍继续出现严重的 COVID-19 疾病，并可能需要呼吸支持。本研究表明，识别此类患者的病情恶化可能是由 PTX 或 PM 引起的，特别是在哮喘患者和接受正压通气治疗的患者中，这一点非常重要。
