Pneumothorax in ARDS hospitalized Covid-19 patients: risk factors, therapeutic strategies and outcome

Abstract

Introduction: Pneumothorax was described as complication in COVID-19 patients although clinical risk predictors for its presentation and the potential role in patient’s outcome is still unclear.

Aim of the study: To assess risk predictors, therapeutic strategies and outcome of ARDS hospitalized COVID-19 patients with pneumothorax.

Methods: We performed a retrospective case-control analysis of 184 patients admitted for severe respiratory failure to our COVID-19 semi-intensive care respiratory unit (SARS-CoV-2 infection confirmed by molecular testing) from october 2020 to march 2021 reporting clinical and radiological features, comorbidities, treatments and outcomes.

Results: The 8% of sample experienced spontaneous PNX (of which 75% right PNX and 8% bilateral PNX). The mean age of whole sample was 76 years, 53% males, 43% were obese, 50.5% current or former smokers, 52.7% had hypertension, 80% had a history of cognitive impairment, 80% had received non-invasive ventilation before pneumothorax. The mean P/F of pneumothorax group at our unit admission was 168. The 100% of them underwent chest dreinage. Their mortality was 83.1% (p<0.001).

Conclusions: PNX may be a complication of severe COVID-19 infection associated with a worse prognosis in terms of mortality, consistently with the possible mechanism of hyperinflammatory form associated with critical illness. In our experience high-flow oxygen therapy may be a safer alternative to avoid the potential fatal occurrence of pneumothorax in COVID-19.