COVID-19 Pneumothorax May Be Linked to Type of Respiratory Support

Approximately 1% of patients with COVID-19 admitted to the hospital develop pneumothorax as a complication, according to the results of a recent study published the European Respiratory Journal.

Researchers used data from the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) to examine COVID-19 pneumothorax occurrence at a population level during the first and second waves of the pandemic in the United Kingdom. Inclusion criteria included patients aged 18 years and older admitted to the hospital with a positive SARS-CoV-2 polymerase chain reaction (PCR) test or were considered highly clinically likely to have COVID-19.

A total of 131,679 patients met the inclusion criteria and were enrolled as study participants. Of these participants, 1283 (0.97%) had a pneumothorax at some stage during their admission. Among that smaller subsection, 68.5% of those were men. The incidence of pneumothorax differed between groups defined by the level of respiratory support they received. Significantly more patients who received invasive ventilation also had pneumothorax (P =.004).

“It is noteworthy that despite an overall similar incidence of pneumothoraces during the first and second waves, the incidence of pneumothorax in patients who received both non-invasive respiratory support and invasive ventilation during their admission was lower in the first than the second wave,” the researchers wrote.

There were several study limitations, including a lack of information on the timing of pneumothoraces on the case report forms of ISARIC, which meant the researchers were unable to establish whether pneumothoraces occurred following the introduction of ventilatory support or if the presence of a pneumothorax results in respiratory deterioration that required intubation. Also, the case report form does not include history of previous pneumothorax nor treatment for pneumothorax.

The researchers added that noninvasive respiratory support requires further study because the risk of pneumothorax appeared to increase in patients who received this treatment but still required invasive ventilation vs patients who underwent early intubation and mechanical ventilation. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Marciniak SJ, Farrell J, Rostron A, et al. COVID-19 Pneumothorax in the United Kingdom: a prospective observational study using the ISARIC WHO clinical characterisation protocol. Eur Respir J. Published online June 17, 2021. doi:10.1183/13993003.00929-2021