Patel Nian, Nicolae Robert, Geropoulos Georgios, Mandal Pallabhi, Christou Chrysanthos D, Gavala Marianna, Madouros Nikolaos, Papapanou Michail, Mogal Rahul, Giannis Dimitrios, Kechagias Konstantinos S, Panagiotopoulos Nikolaos
Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London.
Surgery Working Group, Society of Junior Doctors, Athens, Greece.
Monaldi Arch Chest Dis. 2022 Jul 27;93(2). doi: 10.4081/monaldi.2022.2338.
Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.
纵隔气肿（PNM）是一种罕见的临床发现，通常病程良性，大多数情况下采用保守治疗。然而，在新冠疫情期间，观察到PNM的发病率有所增加。文献中已有多篇关于新冠患者发生PNM的报道，这些患者有的采用保守治疗，有的接受了手术治疗。在本研究中，我们介绍了我们机构在新冠相关PNM方面的经验，提出了一种管理算法，并对当前文献进行了综述。总共确定了43个病例系列，包括747名患者，其中374/747（50.1%）在诊断时已插管，168/747（22.5%）在入院时接受了手术引流，562/747（75.2%）接受了保守治疗（观察或机械通气）。住院死亡率为51.8%（387/747），而45.1%的患者康复和/或出院（337/747）。总之，尽管文献报道新冠患者中PNM的发病率有所增加，但仍难以确定PNM与死亡率之间的真正因果关系。然而，我们可以看到PMN在疾病预后中起着重要作用。由于病情复杂性增加、死亡率高以及相关并发症，保守治疗可能不够，需要采取手术方法。
