The following is a summary of “Pneumothorax in hospitalized COVID-19 patients with severe respiratory failure: Risk factors and outcome,” published in the MARCH 2023 issue of Pulmonology by Ragnoli, et al.

The incidence of pneumothorax (PNX) as a complication in COVID-19 patients is uncommon, and the predictors of risk and the impact on the patient’s outcome are not yet clear. 

Researchers conducted a retrospective observational analysis of 184 severe COVID-19 patients admitted to the respiratory unit from October 2020 to March 2021 to determine the prevalence, predictors, and mortality of PNX. The prevalence of PNX was 8.1%, and the mortality rate was >86% (13/15), which was significantly higher than the mortality rate in patients without PNX (56/169) (P < 0.001). 

Patients with a history of cognitive decline were more likely to develop PNX (HR: 31.18), and it was also more likely in patients who received non-invasive ventilation (NIV) (P < 0.0071) and those with a low P/F ratio (HR: 0.99, P = 0.004). Compared to patients without PNX, the PNX subgroup showed a significant increase in LDH (420 U/L vs. 345 U/L, respectively P = 0.003), ferritin (1,111 mg/dl vs. 660 mg/dl, respectively P = 0.006), and decreased lymphocytes (HR: 4.440, P = 0.004). The high mortality rate associated with PNX in COVID-19 patients may be due to the hyperinflammatory state associated with critical illness, the use of NIV, the severity of respiratory failure, and cognitive impairment. 

They recommended early treatment of systemic inflammation in selected patients showing low P/F ratio, cognitive impairment, and metabolic cytokine storm in association with high-flow oxygen therapy as a safer alternative to NIV to prevent fatalities associated with PNX.

Reference: resmedjournal.com/article/S0954-6111(23)00082-3/fulltext