Spontaneous pneumomediastinum in patients with COVID-19 pneumonia

He diagnosis and estimation of risk factors for spontaneous pneumomediastinum (SPM) are of particular practical interest since the occurrence of this complication can significantly aggravate the course of COVID-19, while having vague clinical manifestations. Purpose of the study - to determine the main clinical and laboratory characteristics, as well as risk factors for a severe course of the disease in patients with COVID-19 pneumonia, complicated by the development of SPM unrelated to invasive ventilation (IV). Material and methods. The study included 130 patients (73 men and 57 women) with COVID-19 pneumonia who were diagnosed with SPM prior to episodes of invasive mechanical ventilation. The average age of the patients was 61±15,3 years. All patients had COVID-19 pneumonia on chest CT, confirmed by PCR testing. Upon admission to the hospital, demographic data, typical complaints, clinical variables and laboratory parameters were collected. Results. SPM was detected in 130 patients, in 29 cases (22%), in addition to pneumomediastinum, unilateral and bilateral pneumothorax of various sizes developed. The most common comorbidities in the examined patients included: hypertension (71%), overweight and obesity (70%), coronary heart disease (20%), diabetes mellitus (15,4%), chronic obstructive pulmonary disease (9,2 %), cancer (9,2%), bronchial asthma (6,2%). Laboratory indicators of the examined patients had characteristic changes for COVID-19 pneumonia. The values of LDH, CRP, D-dimer and ferritin in blood plasma were increased. SPM was detected in the progression stage, with an increase in the volume of lung lesions before CT 3 (19,3%) and CT 4 (80,6%). The timing of SPM development from the onset of the disease was 13,0±7,3 days. Logistic regression showed that predisposing factors (OR 3,94; 95% CI: 1,13-13,6; p=0,031) and radiological severity (OR 6,63; 95% CI: 1,36-32,3; p=0,019) were independently associated with the risk of pneumomediastinum. Conclusion. SPM in patients with COVID-19 who have not used invasive mechanical ventilation occurs in the progression stage, with an increase in the volume of lung lesions according to CT data to 3 and 4 degrees. The formation of SPM is associated with an increase in the severity of COVID-19 pneumonia, an increase in the frequency of use of invasive mechanical ventilation, and a higher risk of death.

COVID-19, spontaneous pneumomediastinum, pneumothorax, pneumonia, coronavirus pneumonia, alveolar air leak syndrome, COVID-19, computed tomography, mechanical ventilation, respiratory support