TY - JOUR T1 - Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02522-2021 SP - 2102522 AU - James Melhorn AU - Andrew Achaiah AU - Francesca M. Conway AU - Elizabeth M. F. Thompson AU - Erik W. Skyllberg AU - Joseph Durrant AU - Neda A. Hasan AU - Yasser Madani AU - Prasheena Naran AU - Bavithra Vijayakumar AU - Matthew J. Tate AU - Gareth E. Trevelyan AU - Irfan Zaki AU - Catherine A. Doig AU - Geraldine Lynch AU - Gill Warwick AU - Avinash Aujayeb AU - Karl A. Jackson AU - Hina Iftikhar AU - Jonathan H. Noble AU - Anthony Y. K. C. Ng AU - Mark Nugent AU - Philip J. Evans AU - Robert A. Hastings AU - Harry R. Bellenberg AU - Hannah Lawrence AU - Rachel L. Saville AU - Nikolas T. Johl AU - Adam N. Grey AU - Huw C. Ellis AU - Cheng Chen AU - Thomas L. Jones AU - Nadeem Maddekar AU - Shahul Leyakathali Khan AU - Ambreen Iqbal Muhammad AU - Hakim Ghani AU - Yadee Maung Maung Myint AU - Cecillia Rafique AU - Benjamin J. Pippard AU - Benjamin R. H. Irving AU - Fawad Ali AU - Viola H. Asimba AU - Aqeem Azam AU - Eleanor C. Barton AU - Malvika Bhatnagar AU - Matthew P. Blackburn AU - Kate J. Millington AU - Nicholas J. Budhram AU - Katherine L. Bunclark AU - Toshit P. Sapkal AU - Giles Dixon AU - Andrew J. E. Harries AU - Mohammad Ijaz AU - Vijayalakshmi Karunanithi AU - Samir Naik AU - Malik Aamaz Khan AU - Karishma Savlani AU - Vimal Kumar AU - Beatriz Lara Gallego AU - Noor A. Mahdi AU - Caitlin Morgan AU - Neena Patel AU - Elen W. Rowlands AU - Matthew S. Steward AU - Richard S. Thorley AU - Rebecca L. Wollerton AU - Sana Ullah AU - David M. Smith AU - Wojciech Lason AU - Anthony J Rostron AU - Najib M Rahman AU - Rob J Hallifax Y1 - 2022/01/01 UR - http://erj.ersjournals.com/content/early/2022/01/27/13993003.02522-2021.abstract N2 - Background There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.Methods A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.Results 377 cases of pneumomediastinum 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 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum 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 airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.Conclusions Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis. ER -