High incidence and mortality of pneumothorax in critically Ill patients with COVID-19.
Xiao-Hui Wang, Jun Duan, Xiaoli Han and 6 others
PMID 33138976WHAT IT FOUND
Pneumothorax occurred in 5 of 9 patients on invasive ventilation, with 80% mortality.
It typically appeared two weeks after breathing difficulty started, often triggered by coughing, recruitment maneuvers, or reducing muscle relaxants.
Key findings
01The incidence of pneumothorax was 56% among patients requiring invasive mechanical ventilation, and 80% of those patients died.
02Pneumothorax events were associated with specific triggers including ineffective recruitment maneuvers, severe coughing, and the reduction of neuromuscular blocking agents.
03All five patients developed lung structural changes such as fibrosis, consolidation, or cysts during treatment, which likely contributed to the pneumothorax risk despite protective ventilation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study includes only five patients, making it impossible to determine general incidence rates or causal relationships. It was retrospective, relying on existing medical records which may have incomplete data. The hospital setting and patient population may not represent all critically ill patients. There was no control group of patients who did not develop pneumothorax to compare risk factors directly. The authors note that informed consent was not obtained due to the epidemic.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not use the 56% incidence rate to predict pneumothorax risk in your own ventilated patients. This figure comes from a tiny sample of five cases selected from a larger group, and the mortality rate reflects the severity of the underlying illness, not just the pneumothorax.