COVID-19 and Spontaneous Pneumomediastinum: A case series.
Alex Diaz, Dolly Patel, Najia Sayedy and 1 others
PMID 33302147WHAT IT FOUND
Three non-smoking men with severe COVID-19 pneumonia, not on positive pressure ventilation, developed pneumomediastinum after two weeks or more.
New chest pain or worsening hypoxemia was the clue, and a chest tube was needed.
Key findings
01Three patients were diagnosed with pneumomediastinum in the absence of positive pressure ventilation.
02A chest tube was placed with improvement in oxygenation, and the pneumothorax and pneumomediastinum resolved.
03Pneumomediastinum on hospital day 36 was likely secondary to violent coughing and improved with conservative management.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case series, so it cannot show how often pneumomediastinum occurs in severe COVID-19 pneumonia or compare outcomes with patients who did not have it. All patients had severe hypoxemia requiring high oxygen support, so it is unclear whether delayed pneumomediastinum was related to coughing, lung injury, or the underlying illness. Each patient received hydroxychloroquine, azithromycin, methylprednisolone, tocilizumab and convalescent plasma together, so no single treatment can be linked to pneumomediastinum. The report does not describe a systematic method for detecting pneumomediastinum, so milder cases may have been missed. Follow-up reports varied between cases, and outcomes were not standardized.
The easy way to misread this
Do not conclude that severe COVID-19 pneumonia commonly causes spontaneous pneumomediastinum. This case series does not report how many severe COVID-19 pneumonia patients were screened, so it cannot show frequency.