TY - JOUR T1 - Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02522-2021 VL - 60 IS - 3 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 - 2022/09/01 UR - http://erj.ersjournals.com/content/60/3/2102522.abstract N2 - Background There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome.Methods A structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicited via respiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality.Results 377 cases of PTM 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 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM 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 airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality.Conclusions PTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.Roughly 0.6% of patients admitted with COVID-19 have pneumomediastinum identified. The finding is associated with severe COVID-19 and high mortality. https://bit.ly/3nXlaR5 ER -