Department of Anesthesiology and Critical Care, Nepal A.P.F. Hospital.
J Nepal Health Res Counc. 2024 Mar 22;21(3):428-438. doi: 10.33314/jnhrc.v21i3.4550.
Pneumothorax, pneumomediastinum and subcutaneous emphysema are respiratory complications of Coronavirus disease 2019 occurring with noteworthy frequency in patients especially with severe disease. They can be life-threatening and often complicate patient managment.
This was a retrospective, observational study of patients admitted in Nepal Armed Police Force hospital from 13/05/2020 to 28/12/2021 diagnosed with pneumothorax, pneumomediastinum or subcutaneous emphysema singly or in combination. Data were collected from clinical charts, imaging records and electronic medical records of Severe Acute Respiratory Syndrome Coronavirus-type 2 positive patients 18 years and older. The frequency and type of the defined complications, the inflammatory markers and ventilatory parameters just prior to their diagnosis, the duration of hospitalization and ICU admission and in-hospital mortality rate were studied.
Out of 4013 COVID-19 patients admitted in the hospital during the period, a total of 28 patients were observed to develop the complications, the overall incidence being 0.7% among hospitalized patients and 5.6% among ICU patients. The proportion of subcutaneous emphysema (64.3%) was highest followed by pneumomediastinum (46.4%) and then pneumothorax (39.3%) existing singly or in combination among the 28 patients, where four patients developed the complications spontaneously. Mean Positive End Expiratory Pressure of 12.1±2.6 cmH2O and Peak Inspiratory Pressure or Pressure Support of 30.9±10.3 cmH2O were observed for patients under positive pressure ventilation. Most of the patients who developed the complications (78.6%) died during treatment.
Pulmonary air leak complications occur frequently in COVID-19 patients treated with or without positive pressure ventilation signifying increased disease severity, risk of ICU admission and high mortality rate. Hence, clinicians should be vigilant of these complications in all patients affected with COVID-19 and institute timely management.
气胸、纵隔气肿和皮下气肿是 2019 年冠状病毒病的呼吸并发症，在患有严重疾病的患者中发生率相当高。它们可能危及生命，并且经常使患者的治疗复杂化。
这是一项回顾性观察性研究，纳入了 2020 年 5 月 13 日至 2021 年 12 月 28 日期间在尼泊尔武装警察部队医院住院的、被诊断为气胸、纵隔气肿或皮下气肿（单独或联合）的患者。从 SARS-CoV-2 阳性患者的临床病历、影像学记录和电子病历中收集数据，纳入年龄≥18 岁的患者。研究了定义并发症的频率和类型、诊断前炎症标志物和通气参数、住院时间、入住 ICU 时间和院内死亡率。
在该医院住院的 4013 例 COVID-19 患者中，共有 28 例患者出现并发症，总发生率为住院患者的 0.7%，ICU 患者的 5.6%。28 例患者中，皮下气肿（64.3%）的比例最高，其次是纵隔气肿（46.4%），然后是气胸（39.3%），其中 4 例患者自发性发生这些并发症。接受正压通气的患者的平均呼气末正压为 12.1±2.6cmH2O，吸气峰压或压力支持为 30.9±10.3cmH2O。大多数发生并发症的患者（78.6%）在治疗过程中死亡。
在接受或不接受正压通气治疗的 COVID-19 患者中，肺空气漏并发症经常发生，表明疾病严重程度增加、入住 ICU 的风险增加和死亡率高。因此，临床医生应该对所有 COVID-19 患者保持警惕，并及时进行管理。
