RT Journal Article
SR Electronic
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
FD European Respiratory Society
SP 2102522
DO 10.1183/13993003.02522-2021
VO 60
IS 3
A1 James Melhorn
A1 Andrew Achaiah
A1 Francesca M. Conway
A1 Elizabeth M.F. Thompson
A1 Erik W. Skyllberg
A1 Joseph Durrant
A1 Neda A. Hasan
A1 Yasser Madani
A1 Prasheena Naran
A1 Bavithra Vijayakumar
A1 Matthew J. Tate
A1 Gareth E. Trevelyan
A1 Irfan Zaki
A1 Catherine A. Doig
A1 Geraldine Lynch
A1 Gill Warwick
A1 Avinash Aujayeb
A1 Karl A. Jackson
A1 Hina Iftikhar
A1 Jonathan H. Noble
A1 Anthony Y.K.C. Ng
A1 Mark Nugent
A1 Philip J. Evans
A1 Robert A. Hastings
A1 Harry R. Bellenberg
A1 Hannah Lawrence
A1 Rachel L. Saville
A1 Nikolas T. Johl
A1 Adam N. Grey
A1 Huw C. Ellis
A1 Cheng Chen
A1 Thomas L. Jones
A1 Nadeem Maddekar
A1 Shahul Leyakathali Khan
A1 Ambreen Iqbal Muhammad
A1 Hakim Ghani
A1 Yadee Maung Maung Myint
A1 Cecillia Rafique
A1 Benjamin J. Pippard
A1 Benjamin R.H. Irving
A1 Fawad Ali
A1 Viola H. Asimba
A1 Aqeem Azam
A1 Eleanor C. Barton
A1 Malvika Bhatnagar
A1 Matthew P. Blackburn
A1 Kate J. Millington
A1 Nicholas J. Budhram
A1 Katherine L. Bunclark
A1 Toshit P. Sapkal
A1 Giles Dixon
A1 Andrew J.E. Harries
A1 Mohammad Ijaz
A1 Vijayalakshmi Karunanithi
A1 Samir Naik
A1 Malik Aamaz Khan
A1 Karishma Savlani
A1 Vimal Kumar
A1 Beatriz Lara Gallego
A1 Noor A. Mahdi
A1 Caitlin Morgan
A1 Neena Patel
A1 Elen W. Rowlands
A1 Matthew S. Steward
A1 Richard S. Thorley
A1 Rebecca L. Wollerton
A1 Sana Ullah
A1 David M. Smith
A1 Wojciech Lason
A1 Anthony J. Rostron
A1 Najib M. Rahman
A1 Rob J. Hallifax
YR 2022
UL http://erj.ersjournals.com/content/60/3/2102522.abstract
AB 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