Atilla PEKÇOLAKLAR, Hasan Oğuz KAPICIBAŞI

COVID-19 pnömonisinde spontan pnömotoraks ve pnömomediastinum

Giriş: Spontan pnömotoraks ve pnömomediastinum, COVID-19 viral pnömonisinin nadir görülen komplikasyonlarıdır ve bu komplikasyonlar büyük ölçüde bilinmemektedir. Bu çalışmada pnömotoraks, pnömomediastinum ve COVID-19 prognozu arasındaki ilişkiyi belirlemeyi amaçladık. Yöntemler: Mart 2020 ile Ocak 2021 arasında pnömotoraks ve pnömomediastinum tanısı alan 82 COVID-19 (+) hasta retrospektif olarak değerlendirildi. Demografik bilgiler, laboratuvar değerlendirmeleri, radyolojik değerlendirmeler (PA akciğer, Toraks BT), klinik yönetim, prognoz ve sağkalım dahil olmak üzere hastaların tıbbi kayıtlarından veriler elde edildi. Bulgular: Hastaların 74'ünde (%90,2) laboratuvar tarafından kanıtlanmış COVID-19 bulunurken, 8 (%9,8) hastaya klinik tablo ve bilgisayarlı tomografi (BT) bulgularına göre tanı konuldu. Yetmiş altı hastada (%92,7) pnömotoraks, 10 hastada (%12,1) ek olarak pnömomediastinum varken ve 6 hastada (%7,3) izole pnömomediasten vardı. Pnömotoraks süresinde mekanik ventilasyon varlığına (medyan: 8,55, IQR: 13) gün) veya yokluğuna (medyan: 2,5, IQR: 10) göre istatiksel anlamlı bir fark yoktu (Mann-Whitney UZ=1,548, p= 0,122). İnflamatuvar belirteçlerin çoğu ve kan gazı değerleri, ölen ve hayatta kalan hastalar arasında önemli ölçüde farklılık gösterdi (p<0,05). Tek değişkenli analizde yaş, tedavi grupları ve komorbiditelerin varlığı sağkalım ile ilişkili önemli değişkenlerdi. Çok değişkenli analizlerde, pH ve cinsiyetin hayatta kalmanın tek önemli bağımsız belirleyicisi olduğunu ortaya çıkardı. Sonuç: Spontan pnömotoraks ve pnömomediastinum, COVID-19 viral pnömonisinin nadir komplikasyonlarıdır. Hastalığın seyri sırasında herhangi bir zamanda ortaya çıkabilirler. Genel olarak, mekanik ventilasyona maruz kalan komorbiditeleri olan yaşlı hastalar artmış risk altında görünmektedir.

Anahtar Kelimeler:

SARS-CoV-2, pnömotoraks, pnömomediastinum, komplikasyon, mortalite

Spontaneous Pneumothorax and Pneumomediastinum in COVID-19 Pneumonia

Introduction: Spontaneous pneumothorax and pneumomediastinum are uncommon complications of COVID-19 viral pneumonia and these complications remain unknown largely. This study aimed to determine the relationship between pneumothorax, pneumomediastinum, and COVID-19 prognosis. Methods: Between March 2020 and January 2021, 82 COVID-19 (+) patients diagnosed with pneumothorax and pneumomediastinum were evaluated retrospectively. Data were obtained from the medical records of the patients, including demographic information, laboratory evaluations, radiological evaluations (PA lung, Thorax CT), clinical management, prognosis, and survival. Results: While 74 (90.2%) of the patients had COVID-19 proven by the laboratory, 8 (9.8%) patients were diagnosed based on their clinical picture and computed tomography (CT) findings. Seventy-six patients (92.7%) had pneumothorax, while 10 (12.1%) had additional pneumomediastinum and 6 patients (7.3%) isolated pneumomediastinum. There was no significant difference in the median duration of pneumothorax based on the presence (median: 8.55, IQR: 13) days) or absence (median: 2.5, IQR: 10) of mechanical ventilation (Mann-Whitney U Z=1.548, p=0.122). Most of the inflammatory markers as well as blood gas values differed significantly between the deceased and survived patients (p<0.05). Age, treatment groups, and the presence of comorbidities were the significant variables associated with survival in univariate analyses. A multivariate analysis revealed pH and sex as the only significant independent predictors of survival. Conclusion: Spontaneous pneumothorax and pneumomediastinum are rare complications of COVID-19 viral pneumonia. They can occur at any time during the course of the disease. In general, elderly patients with comorbidities who are exposed to mechanical ventilation seem to be at increased risk.

Keywords:

SARS-CoV-2, Pneumothorax, Pneumomediastinum, Complications, Mortality,

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