PT - JOURNAL ARTICLE AU - Anthony W. Martinelli AU - Tejas Ingle AU - Joseph Newman AU - Iftikhar Nadeem AU - Karl Jackson AU - Nicholas D. Lane AU - James Melhorn AU - Helen E. Davies AU - Anthony J. Rostron AU - Aldrin Adeni AU - Kevin Conroy AU - Nicholas Woznitza AU - Matthew Matson AU - Simon E. Brill AU - James Murray AU - Amar Shah AU - Revati Naran AU - Samanjit S. Hare AU - Oliver Collas AU - Sarah Bigham AU - Michael Spiro AU - Margaret M. Huang AU - Beenish Iqbal AU - Sarah Trenfield AU - Stephane Ledot AU - Sujal Desai AU - Lewis Standing AU - Judith Babar AU - Razeen Mahroof AU - Ian Smith AU - Kai Lee AU - Nairi Tchrakian AU - Stephanie Uys AU - William Ricketts AU - Anant R.C. Patel AU - Avinash Aujayeb AU - Maria Kokosi AU - Alexander J.K. Wilkinson AU - Stefan J. Marciniak TI - COVID-19 and Pneumothorax: A Multicentre Retrospective Case Series AID - 10.1183/13993003.02697-2020 DP - 2020 Jan 01 TA - European Respiratory Journal PG - 2002697 4099 - http://erj.ersjournals.com/content/early/2020/09/03/13993003.02697-2020.short 4100 - http://erj.ersjournals.com/content/early/2020/09/03/13993003.02697-2020.full AB - Introduction Pneumothorax and pneumomediastinum have both been noted to complicate cases of COVID-19 requiring hospital admission. We report the largest case series yet described of patients with both these pathologies that includes non-ventilated patients.Methods Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival.Results Seventy-one patients from 16 centres were included in the study, of whom 60 patients had pneumothoraces (six also with pneumomediastinum), whilst 11 patients had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication whilst intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1%±6.5%) or isolated pneumomediastinum (53.0%±18.7%; p=0.854). The incidence of pneumothorax was higher in males. The 28-day survival was not different between the sexes (males 62.5%±7.7% versus females 68.4%±10.7%; p=0.619). Patients above the age of 70 had a significantly lower 28-day survival than younger individuals (≥70 years 41.7%±13.5% survival versus <70 years 70.9%±6.8% survival; p=0.018 log-rank).Conclusion These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage active treatment to be continued where clinically possible.Roughly 1% of patients admitted with COVID-19 develop pneumothorax. This can occur without pre-existing lung disease or mechanical ventilation. Two thirds of patients survive, but age >70 years and acidosis are associated with poor prognosis.