Epidemiology, Risk Factors and Outcomes of Pneumomediastinum in Patients with Coronavirus Disease 2019: A Case-Control Study

Alexandra E Reis; Nader Emami; Sudham Chand; Funmilola Ogundipe; Daniel L Belkin; Kenny Ye; Adam B Keene; Jeffrey M Levsky

doi:10.1177/08850666211040417

Epidemiology, Risk Factors and Outcomes of Pneumomediastinum in Patients with Coronavirus Disease 2019: A Case-Control Study

J Intensive Care Med. 2022 Jan;37(1):12-20. doi: 10.1177/08850666211040417. Epub 2021 Sep 13.

Authors

Alexandra E Reis¹, Nader Emami², Sudham Chand², Funmilola Ogundipe², Daniel L Belkin¹, Kenny Ye^{3

4}, Adam B Keene¹, Jeffrey M Levsky^{1

5}

Affiliations

¹ Division of Cardiothoracic Imaging, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA.
² Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA.
³ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, The Bronx, USA.
⁴ Department of Systems and Computational Biology, Albert Einstein College of Medicine, The Bronx, USA.
⁵ Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA.

PMID: 34515571
DOI: 10.1177/08850666211040417

Abstract

Background: Since the beginning of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, pneumomediastinum has been reported in patients with COVID-19 pneumonia and acute respiratory distress syndrome. It has been suggested that pneumomediastinum may portend a worse outcome in such patients although no investigation has established this association definitively. Research Question: We hypothesized that the finding of pneumomediastinum in the setting of COVID-19 disease may be associated with a worse clinical outcome. The purpose of this study was to determine if the presence of pneumomediastinum was predictive of increased mortality in patients with COVID-19. Study Design and Methods: A retrospective case-control study utilizing clinical data and imaging for COVID-19 patients seen at our institution from 3/7/2020 to 5/20/2020 was performed. 87 COVID-19 positive patients with pneumomediastinum were compared to 87 COVID-19 positive patients without pneumomediastinum and to a historical group of patients with pneumomediastinum during the same time frame in 2019. Results: The incidence of pneumomediastinum was increased more than 6-fold during the COVID-19 pandemic compared to 2019 (P = <.001). 1.5% of all COVID-19 patients and 11% of mechanically ventilated COVID-19 patients at our institution developed pneumomediastinum. Patients who developed pneumomediastinum had a significantly higher PEEP and lower P/F ratio than those who did not (P = .002 and .033, respectively). Pneumomediastinum was not found to be associated with increased mortality (P = .16, confidence interval [CI]: 0.89-2.09, 1.37). The presence of concurrent pneumothorax at the time of pneumomediastinum diagnosis was associated with increased mortality (P = .013 CI: 1.15-3.17, 1.91). Conclusion: Pneumomediastinum is not independently associated with a worse clinical prognosis in COVID-19 positive patients. The presence of concurrent pneumothorax was associated with increased mortality.

Keywords: Coronavirus disease 2019; barotrauma; intubation; pneumomediastinum; pneumothorax.

MeSH terms

COVID-19*
Case-Control Studies
Humans
Mediastinal Emphysema* / diagnostic imaging
Mediastinal Emphysema* / epidemiology
Mediastinal Emphysema* / etiology
Pandemics
Retrospective Studies
Risk Factors
SARS-CoV-2