Document Type : Case Report
Authors
Department of Anaesthesia, Shaheed Hasan Khan Mevati Government Medical College, Haryana, India
Abstract
Objective: Since April 2021, there has been significant increase in number of COVID-19 cases in India. As the caseload increased, so did the complications like pneumomediastinum (PM) and subcutaneous emphysema (SE).
Case Presentation: We present clinical course of 4 patients as case series of COVID-19 pneumonia who developed PM and SE during their management. Two cases with the need of non-invasive ventilation (NIV) recovered and two cases that needed invasive mechanical ventilation (IMV) ultimately expired.
Conclusion: This case series highlights the importance of positive pressure ventilation via NIV and IMV as a predisposing factor for PM and SE as well as the need of strict vigilance by clinicians managing COVID-19 patients in IMV.
Keywords
Main Subjects
2. Xie J, Covassin N, Fan Z, Singh P, Gao W, Li G, et al. Association between hypoxemia and mortality in patientswith COVID-19. Mayo Clin Proc 2020; 95(6): 1138-47. doi:10.1016/j.mayocp.2020.04.006.
3. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: a review. Clin Immunol 2020; 215: 108427.doi: 10.1016/j.clim.2020.108427.
4. World Health Organization (WHO). Clinical Management of Severe Acute Respiratory Infection ( SARI) when COVID-19 Disease is Suspected: Interim Guidance, 13 March 2020.WHO; 2020.
5. Zhou C, Gao C, Xie Y, Xu M. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis 2020; 20(4): 510. doi:10.1016/s1473-3099(20)30156-0.
6. Anzueto A, Frutos-Vivar F, Esteban A, Alía I, Brochard L, Stewart T, et al. Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Med 2004; 30(4): 612-9. doi: 10.1007/s00134-004-2187-7.
7. Wali A, Rizzo V, Bille A, Routledge T, Chambers AJ. Pneumomediastinum following intubation in COVID-19
patients: a case series. Anaesthesia 2020; 75(8): 1076-81. doi:10.1111/anae.15113.
8. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute
respiratory distress syndrome. Lancet Respir Med 2020; 8(4): 420-2. doi: 10.1016/s2213-2600(20)30076-x.
9. Goldman N, Ketheeswaran B, Wilson H. COVID-19-associated pneumomediastinum. Clin Med (Lond) 2020; 20(4): e91-e2. doi: 10.7861/clinmed.2020-0247.
10. Thein OS, Niazi M, Ali A, Sahal A. Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive
ventilation. BMJ Case Rep 2021; 14(3): e241809. doi:10.1136/bcr-2021-241809.
11. Wang J, Su X, Zhang T, Zheng C. Spontaneous pneumomediastinum: a probable unusual complication of
coronavirus disease 2019 (COVID-19) pneumonia. Korean J Radiol 2020; 21(5): 627-8. doi: 10.3348/kjr.2020.0281.
12. Jacobi A, Chung M, Bernheim A, Eber C. Portable chest X-ray in coronavirus disease-19 (COVID-19): a pictorial
review. Clin Imaging 2020; 64: 35-42. doi: 10.1016/j.clinimag.2020.04.001.
13. Eperjesiova B, Hart E, Shokr M, Sinha P, Ferguson GT. Spontaneous pneumomediastinum/pneumothorax in patients
with COVID-19. Cureus 2020; 12(7): e8996. doi: 10.7759/cureus.8996.
14. López Vega JM, Parra Gordo ML, Diez Tascón A, Ossaba Vélez S. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease. Emerg Radiol 2020; 27(6): 727-30. doi: 10.1007/s10140-020-01806-0.
15. Mart MF, Norfolk SG, Flemmons LN, Stokes JW, Bacchetta MD, Trindade AJ, et al. Pneumomediastinum in acute respiratory distress syndrome from COVID-19. Am J Respir Crit Care Med 2021; 203(2): 237-8. doi:10.1164/rccm.202008-3376IM.
16. Kangas-Dick A, Gazivoda V, Ibrahim M, Sun A, Shaw JP, Brichkov I, et al. Clinical characteristics and outcome of
pneumomediastinum in patients with COVID-19 pneumonia. J Laparoendosc Adv Surg Tech A 2021; 31(3): 273-8. doi:
10.1089/lap.2020.0692.
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