PMID- 35584831
OWN - NLM
STAT- MEDLINE
DCOM- 20220520
LR  - 20240426
IS  - 1473-4893 (Electronic)
IS  - 1470-2118 (Print)
IS  - 1470-2118 (Linking)
VI  - 22
IP  - 3
DP  - 2022 May
TI  - The clinical course of pneumomediastinum in patients with SARS-CoV-2 before 
      invasive mechanical ventilation.
PG  - 271-275
LID - 10.7861/clinmed.2021-0441 [doi]
AB  - Pneumomediastinum and pneumothorax are recognised complications encountered in 
      COVID-19 before or during invasive mechanical ventilation (IMV). The clinical 
      course of patients developing pneumomediastinum before IMV is yet to be 
      evaluated.Four-thousand, one-hundred and thirty-one patients hospitalised with 
      COVID-19 over a 12-month period were retrospectively reviewed to evaluate for 
      incidence, clinical characteristics and outcomes. A subgroup analysis was done to 
      identify any clinical traits between survivors and non-survivors. The overall 
      incidence of pneumomediastinum prior to IMV was 0.92% (n=38) and was seen at 
      admission or during non-invasive respiratory support. Thirty-seven per cent had 
      associated pneumothorax most commonly unilateral (right side). The median 
      (interquartile range (IQR)) duration from admission to developing 
      pneumomediastinum was 7 days (3-11) and complete resolution was seen in 53% of 
      patients; median (IQR) duration to resolution was 8 days (4-17). The in-hospital 
      mortality associated with pneumomediastinum in patients with SARS-CoV-2 
      (PneumoCoV) was 55%. Increasing age (68 +/- 12 years vs 56 +/- 14 years; p=0.01), 
      higher body mass index (31 +/- 5 kg/m(2) vs 28 +/- 5 kg/m(2); p=0.04), lack of 
      resolution of pneumomediastinum (67% vs 24%; p=0.01; odds ratio (OR) 6.5; 95% 
      confidence interval (CI) 1.5-27.5), presence of concurrent pneumothorax (65% vs 
      14%; p=0.002; OR 11; 95% CI 2.2-53.1) and elevated procalcitonin levels (>0.5 
      ng/mL; 81% vs 41%; p=0.01; OR 6; 95% CI 1.4-26) were significant features in 
      those who did not survive.The incidence of PneumoCoV, despite being low, is 
      associated with increased mortality. It is a hallmark of moderate to severe 
      disease with multifaceted contributory factors. Both demographic and clinical 
      factors predict survival.
CI  - (c) Royal College of Physicians 2022. All rights reserved.
FAU - Dwarakanath, Akshay
AU  - Dwarakanath A
AD  - The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK akshay.dwarakanath@nhs.net.
FAU - Horgan, Laura
AU  - Horgan L
AD  - The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
FAU - Jayawardena, Manika
AU  - Jayawardena M
AD  - The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
FAU - Thirumaran, Muthu
AU  - Thirumaran M
AD  - The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
FAU - Johnson, Owen
AU  - Johnson O
AD  - The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Clin Med (Lond)
JT  - Clinical medicine (London, England)
JID - 101092853
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *COVID-19/complications/therapy
MH  - Humans
MH  - *Mediastinal Emphysema/epidemiology/etiology/therapy
MH  - Middle Aged
MH  - *Pneumothorax/epidemiology/etiology/therapy
MH  - Respiration, Artificial/adverse effects
MH  - Retrospective Studies
MH  - SARS-CoV-2
PMC - PMC9135094
OTO - NOTNLM
OT  - SARS-CoV-2
OT  - pneumomediastinum
OT  - pneumothorax
OT  - pulmonary complication
OT  - respiratory failure
EDAT- 2022/05/19 06:00
MHDA- 2022/05/21 06:00
PMCR- 2022/05/01
CRDT- 2022/05/18 20:33
PHST- 2022/05/18 20:33 [entrez]
PHST- 2022/05/19 06:00 [pubmed]
PHST- 2022/05/21 06:00 [medline]
PHST- 2022/05/01 00:00 [pmc-release]
AID - S1470-2118(24)02966-X [pii]
AID - clinmedicine [pii]
AID - 10.7861/clinmed.2021-0441 [doi]
PST - ppublish
SO  - Clin Med (Lond). 2022 May;22(3):271-275. doi: 10.7861/clinmed.2021-0441.