Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.

Abstract

BACKGROUND:

There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.

METHODS:

A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.

RESULTS:

377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.

CONCLUSIONS:

Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

• Authors: James Melhorn, Andrew Achaiah, Francesca M Conway, Elizabeth M F Thompson, Erik W Skyllberg, Joseph Durrant, Neda A Hasan, Yasser Madani, Prasheena Naran, Bavithra Vijayakumar, Matthew J Tate, Gareth E Trevelyan, Irfan Zaki, Catherine A Doig, Geraldine Lynch, Gill Warwick, Avinash Aujayeb, Karl A Jackson, Hina Iftikhar, Jonathan H Noble, Anthony Y K C Ng, Mark Nugent, Philip J Evans, Robert A Hastings, Harry R Bellenberg, Hannah Lawrence, Rachel L Saville, Nikolas T Johl, Adam N Grey, Huw C Ellis, Cheng Chen, Thomas L Jones, Nadeem Maddekar, Shahul Leyakathali Khan, Ambreen Iqbal Muhammad, Hakim Ghani, Yadee Maung Maung Myint, Cecillia Rafique, Benjamin J Pippard, Benjamin R H Irving, Fawad Ali, Viola H Asimba, Aqeem Azam, Eleanor C Barton, Malvika Bhatnagar, Matthew P Blackburn, Kate J Millington, Nicholas J Budhram, Katherine L Bunclark, Toshit P Sapkal, Giles Dixon, Andrew J E Harries, Mohammad Ijaz, Vijayalakshmi Karunanithi, Samir Naik, Malik Aamaz Khan, Karishma Savlani, Vimal Kumar, Beatriz Lara Gallego, Noor A Mahdi, Caitlin Morgan, Neena Patel, Elen W Rowlands, Matthew S Steward, Richard S Thorley, Rebecca L Wollerton, Sana Ullah, David M Smith, Wojciech Lason, Anthony J Rostron, Najib M Rahman, Rob J Hallifax
• Journal: The European respiratory journal (Eur Respir J) (May 12 2022) ISSN: 1399-3003 [Electronic] England
• PMID: 35144988 (Publication Type: Journal Article)
• Copyright: Copyright ©The authors 2022.