The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review.
Woon H Chong, Biplab K Saha, Kurt Hu and 1 others
PMID 34087677WHAT IT FOUND
Pneumothorax was rare in hospitalized COVID-19 patients, 0.3% overall, but reached 12.8% among those on mechanical ventilation.
It was often right-sided, appeared 9.0 to 19.6 days after admission, and mortality reached 74.2% among those affected.
Key findings
01In hospitalized COVID-19 patients, pneumothorax was reported in 0.3% (242/79,510), but the incidence was 12.8% in a study of 601 critically ill patients requiring invasive mechanical ventilation.
02Among patients with pneumothorax, it was commonly unilateral and right-sided in 56.9% (74/130), and chest tube insertion was required in up to 64.0% (87/136).
03Mortality among patients diagnosed with pneumothorax was up to 74.2% (69/93), and patients with pneumothorax had longer hospitalization (21.5 to 25.0 days versus 11.0 to 18.0 days) than those without.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All nine included studies were observational and retrospective, so they describe associations rather than proof that COVID-19 caused pneumothorax. Pneumothorax was often a secondary or incidental finding rather than the main outcome, and incidence varied widely across studies. Chest imaging was inconsistent, and many diagnoses relied on CT rather than chest radiographs, which could affect detection and timing. Non-English studies were excluded, and studies with fewer than 40 patients or iatrogenic pneumothorax were excluded, so the picture may be incomplete. Ventilator and respiratory data were available for only a few studies, so the role of ventilation settings cannot be clarified. The review cannot determine whether ECMO improved survival in patients with pneumothorax because evidence was limited.
Declared interests
The authors reported no funding and no competing interests.
The easy way to misread this
Do not read this review as proof that pneumothorax caused death or that ventilator settings caused pneumothorax. The included studies were observational, pneumothorax was often a secondary finding, and the authors state that a causal relationship cannot be concluded.