Indian Journal of Respiratory Care

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VOLUME 12 , ISSUE 2 ( April-June, 2023 ) > List of Articles

Original Article

Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema in COVID-19 Patients: A Monocentric Cohort Study

Youssef Motiaa, Rim Essaoud, Mohammed T Bennani, Abdellah Darraz, Lamyae Y Martahe, Mohammed Aabdi, Siham A Rachidi, Ounci Es-saad, Smael Labib, Hicham Sbai

Keywords : Coronavirus disease 2019, Pneumomediastinum, Pneumothorax, Subcutaneous emphysema

Citation Information : Motiaa Y, Essaoud R, Bennani MT, Darraz A, Martahe LY, Aabdi M, Rachidi SA, Es-saad O, Labib S, Sbai H. Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema in COVID-19 Patients: A Monocentric Cohort Study. Indian J Respir Care 2023; 12 (2):146-150.

DOI: 10.5005/jp-journals-11010-1048

License: CC BY-NC-SA 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Pneumomediastinum (PMD) and pneumothorax (PNO) associated with subcutaneous emphysema (SCE) were described as complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Macklin effect and diffuse alveolar damage due to coronavirus disease 2019 (COVID-19) are the main implicated pathophysiological mechanisms. These complications are associated with hyperinflammation reactions leading to a high-risk of morbidity and mortality. The aim of this article is to describe our series of COVID-19 patients admitted to the intensive care unit (ICU) and conventional hospitalization. Materials and methods: We conducted a retrospective study in Duc de Tovar and Mohammed VI hospitals in Tangier, Morocco, that included all COVID-19 patients hospitalized from 14th March 2020 to 21st March 2021 who developed on admission or during their hospital stay a PMD, a PNO, and or an SCE. Results: Of 216,96 patients who tested positive for SARS-CoV-2, 25 were included and analyzed. The median age was 59-year-old (49–65.5) with male predominance. Diabetes and cardiovascular diseases were the most encountered comorbidities. Our patients were critically ill with a median respiratory rate of 30 breaths/minute, a median oxygen saturation of 77%, and a median lung damage of 60% (30, 75) of the pulmonary parenchyma. Laboratory investigations showed various abnormalities [high levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), neutrophils/lymphocytes ratio, D-dimers, and low levels of lymphocytes], which are independent risk factors of mortality. Some of these factors allowed for predicting the development of these complications. Conclusion: Pneumomediastinum (PMD) in COVID-19 patients reflects diffuse alveolar damage due to hyperinflammation. It can be isolated or associated with PNO and/or SCE. These complications were reported in most seriously-ill COVID-19 patients. Comparative studies are needed to identify predictive and prognosis factors.

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