Background: Rapid clinical deterioration of patients with COVID-19 pneumonia has three potential causes including: Disease progression, pulmonary embolism, and pneumothorax. Pneumothorax is a serious complication in patients with parenchymal lung disease, which may require rapid intervention.
Objective: This study aimed to review management and outcome of spontaneous pneumothorax in our hospitalized non-ventilated patients with COVID-19 pneumonia, and to evaluate the relation of pneumothorax with in-hospital outcome.
Patients and methods: This retrospective study included non-ventilated patients who had spontaneous pneumothorax associated with moderate or severe COVID-19 pneumonia. Pneumothorax was managed considering hemodynamics and size of pneumothorax. When indicated, tube thoracostomy was performed under strict protective measures.
Results: There were 12 cases of spontaneous pneumothorax out of 136 initially non-ventilated COVID-19 patients (8.82%), with median age of 62.5 years. The imaging features included unilateral pneumothorax (91.7%), bilateral pneumothorax (8.3%), subcutaneous emphysema (41.7%), tension pneumothorax (16.7%), pneumomediastinum (16.7%), and hydropneumothorax (8.3%). After median hospital stay of 13 days, the recovery rate was 41.7%, while death was reported in 58.3%. Treatment of pneumothorax was conservative in 58.3% and tube thoracostomy in 41.7% with median chest tube duration of 4 days. Pneumothorax resolved in all patients with no need for further surgical intervention. In comparison with survivors, died patients had higher frequency of severe pneumonia (P= 0.02) and higher ferritin levels (P= 0.04). Severe pneumonia at presentation and the need for invasive ventilation later on had significant impacts on survival after presentation of pneumothorax (P-values of Log Rank test = 0.011 and 0.027 respectively).
Conclusion: Pneumothorax is a rare but serious complication of COVID-19, which requires early diagnosis and treatment. Presentation with severe pneumonia and later on deterioration affected prognosis of initially non-ventilated COVID-19 patients with spontaneous pneumothorax.