Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey
J. Mark Melhorn, Andrew Achaiah, Francesca Conway, Elizabeth Thompson, Erik Skyllberg, Joseph Durrant, Neda A. Hasan, Yasser Madani, Prasheena Naran, Bavithra Vijayakumar, Matthew Tate, Gareth Trevelyan, Irfan Zaki, Catherine A. Doig, Geraldine Lynch, Gill Warwick, Avinash Aujayeb, Karl Jackson, Hina Iftikhar, J Noble, Anthony Ng, Mark Nugent, Philip J. Evans, Robert Hastings, Harry Bellenberg, Hannah Lawrence, Rachel Louise Saville, N. Johl, Adam N. Grey, Huw Ellis, Cheng Chen, Thomas Jones, Nadeem Maddekar, Shahul Khan, Ambreen Iqbal Muhammad, Hakim Ghani, Yadee Myint, Cecillia Rafique, Benjamin Pippard, Benjamin R.H. Irving, Fawad Ali, Viola H. Asimba, Aqeem Azam, Eleanor Barton, Malvika Bhatnagar, Matthew P. Blackburn, Kate J. Millington, Nicholas J. Budhram, Katherine Bunclark, Toshit P. Sapkal, Giles Dixon, Andrew J.E. Harries, M. Khalid Ijaz, Vijayalakshmi Karunanithi, Samir Naik, Malik A Khan, Karishma Savlani, Vimal Kumar, Beatriz Lara, Noor Mahdi, Caitlin Morgan, Neena Patel, Elen Rowlands, Matthew Steward, Richard S. Thorley, Rebecca Wollerton, Sana Ullah, David M. Smith, Wojciech Lason, Anthony Rostron, Najib M. Rahman, Rob Hallifax
Abstract
BACKGROUND: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome. METHODS: respiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality. RESULTS: 377 cases of PTM 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 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM 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 airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality. CONCLUSIONS: PTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.