# Prognostic Implications of Pneumothorax and Pneumomediastinum in COVID-19 Pneumonia: A Cross-Sectional Analysis

## TL;DR

This study finds that pneumothorax and pneumomediastinum in COVID-19 patients are linked to higher mortality, likely due to severe lung damage rather than the events themselves.

## Contribution

The study provides new evidence that barotrauma events in COVID-19 pneumonia are strong indicators of severe disease and increased mortality.

## Key findings

- Patients with pneumothorax or pneumomediastinum had a 69.7% mortality rate compared to 24.5% in those without.
- Most events occurred in patients with severe lung involvement on CT scans.
- Events were common in patients on supplemental oxygen or high-flow nasal cannula, not just ventilated patients.

## Abstract

The prognostic implications of developing pneumothorax (PT) or pneumomediastinum (PM) in COVID-19 pneumonia remain a topic of debate, with current literature showing conflicting data. We aimed to assess mortality rates and the characteristics of patients with COVID-19 pneumonia who developed these complications compared to those who did not.

We analyzed data and outcomes for patients aged 18 years or older who were admitted for COVID-19 pneumonia to a tertiary care referral center in Lebanon.

A total of 527 patients (356 men and 171 women) were identified. Events were reported in 43 patients (18 PM, 10 PT, and 15 both). Overall mortality was 28.3%. Mortality was significantly higher in patients with events compared to those without events (69.7% vs. 24.5%). Most events occurred in patients with severe lung involvement on computed tomography (CT). Only three patients died within the first 48 hours after the development of an event. Incidence was higher in patients who were overweight or obese and increased with age. Distribution was similar between both genders. Ventilation data showed that 79% of events occurred during non-invasive or invasive mechanical ventilation.

Barotrauma events, including PT and PM in COVID-19 pneumonia, were associated with significantly higher mortality and appear to reflect more severe lung involvement. Mortality was not directly caused by the events themselves. A significant proportion occurred in patients on supplemental oxygen or high-flow nasal cannula (21%), highlighting the need for a high index of suspicion for such events even in non-ventilated patients.

There is a strong association between the development of PT and/or PM and mortality in COVID-19 pneumonia.