Another possible COVID complication: ‘punctured lung’

1 in 100 hospitalized patients with COVID-19 may experience a pneumothorax, or perforated lung, according to a Multicator Observatory case series published yesterday European Respiratory Journal.

Pneumothorax usually occurs in very young young men or older patients with severe underlying lung disease. But researchers at the University of Cambridge identified COVID-19 patients, none of whom had symptoms in the lines, including the lungs or pneumomedicinum (air or gas in the area between the lungs) from 16 June until March 16 in 16 hospitals. Leakage of).

“We started watching [COVID-19] “Patients with a perforated lung, even those who were not put on ventilators,” said Stephen Marsiniak, MB BCIH, PhD, from the University of Cambridge, in a news release. To see if It was a real union, I put it. Callouts to respiratory aides across the UK via Twitter. The response was dramatic – it was clearly something that others in the area were watching. ”

Sixty patients with 71 COVID-19 included in the study had two puncture lungs with varying episodes of pneumothorax for a total of 62 punctures. Of the 60 patients with pneumothorax, six also had pneumomedistinum, while 11 patients had pneumomedistinum only.

Age, acidosis, and survival

Nine patients with shortness of breath at the hospital were diagnosed as puncture lungs on an X-ray of the chest, of which 5 were readmitted to hospital after COVID-19 treatment (4 patients) or coronavirus in hospital (1) Was detected to be infected with. All patients in this group were over 40 years of age, and only two had underlying lung disease.

Seven out of nine patients require chest drain. Two (22%) died 7 and 10 days after pneumothorax, one did not require a chest drain and one had the drain removed after the pneumothorax was cured. The remaining seven patients were discharged from the hospital after a median stay of 7 days.

Fourteen patients experienced pneumothorax during their hospitalization while breathing on a normal or respiratory ward; Six of them were diagnosed by coincidence. Three patients were on noninvasive ventilation at the time of diagnosis. Eleven patients required chest drains, while one required surgical intervention. Three patients (21%) died, the rest were discharged from the hospital after a median stay of 35 days, and one was subsequently readmitted due to pneumothorax of the other lung.

Forty-eight patients had a total of 39 lung punctures while receiving invasive ventilation; 26 required only aggressive ventilation, while 12 required oxygen was added to the blood outside their body.

Of the 26 patients requiring invasive ventilation only, perforated lungs were diagnosed concomitantly or because they required more oxygen, revealing hypercapnia (too much or slow breathing in carbon dioxide) and acidosis. , A buildup of acid that is caused by the lungs or kidneys. Seven patients were given a chest drain, and eight survived for at least 28 days.

There was no significant difference in 28-day survival after puncture lung or pneumomedistinum (63.1% vs. 53%); P = 0.85) or between men and women (62.5% vs. 68.4%, P = 0.62). However, men were three times more likely to have pneumothorax than women, which the authors said might be because men with COVID-19 are more prone to severe illness. No patient requires treatment with pneumomedistinum.

The survival rate was only 41.7% compared to patients 70 years and older, while younger patients had 70.9% (P = 0.02), and in patients with acidosis, regardless of age, there was only 3 age.1% chance of 2-day survival, 2.6% of their peers.

Severe but treatable condition

The authors noted that previous small retrospective studies suggested that 1% of hospitalized COVID-19 patients may have perforated lungs and those dying of their infection and 2% who require intensive care, while one Other studies have estimated rates of Berchotrauma (Pneumothorax and Pneumoedistinum) at 15%.

A case report yesterday outside of China highlights the importance of being on guard for spontaneous pneumothorax, or suddenly collapsed lungs, especially in COVID-19 patients with prolonged severe lung damage.

Studies have also suggested that other coronaviruses may contribute to pneumothorax. In a 2004 study, SARS (severe acute respiratory syndrome) was also associated with spontaneous pneumothorax, occurring in 1.7% of hospitalized patients. Similarly, in a 2015 study, a perforated lung was found to be a predictor of worsening disease in patients with MERS (Middle East Respiratory Syndrome).

The authors of the new study stated that COVID-19 may be a cause of lung ulcers that can cause lung puncture. He advised doctors to consider the possibility of perforated lungs in COVID-19 patients, even in those who do not fit the profile for it, as many study patients only incidentally have the condition. Was diagnosed.

While an observational case series cannot prove that COVID-19 causes pneumothorax, the authors stated that the number of affected patients in their study does not make it likely that all lung punches were coincident. They stated that if there was no correlation between the two conditions, they would probably observe only 18 cases of lung puncture in COVID-19 patients from January 22 to July 3.

While previous studies have suggested that pneumothorax is a predictor of poor outcomes, the authors noted that the patients in the study had an overall 63.1% survival rate and that 52% were released from hospital.

“These cases suggest that pneumothorax is a complication of COVID-19,” he wrote. “Pneumothorax does not appear to be an independent marker of worsening disease and we encourage active treatment to continue where clinical is possible.”

Co-author Anthony Martinelli, a respiratory physician at Broomfield Hospital, MB BCer, said in a news release, “Although a perforated lung is a very serious condition, fewer than 70 patients with COVID-19 respond to treatment. Or people with abnormally acidic blood are at a greater risk of death and therefore may require more specialist care. “