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Pakistan Journal of Medical Sciences 2022COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional... (Review)
Review
OBJECTIVES
COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients.
METHODS
The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion.
RESULTS
A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients' death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001).
CONCLUSION
With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn't find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies' design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes' incidence, risk factors, and outcomes in COVID-19 patients.
PubMed: 35480506
DOI: 10.12669/pjms.38.3.5529 -
Journal of Korean Medical Science Mar 2016Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but...
Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
Topics: Aged; Cardiac Tamponade; Drainage; Dyspnea; Emergency Medical Services; Heart Ventricles; Humans; Male; Medical Errors; Pericardial Effusion; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 26952636
DOI: 10.3346/jkms.2016.31.3.470 -
International Journal of Surgery Case... 2016Pneumopericardium, defined as the presence of gas in the pericardial sac, is a rare condition caused mostly by trauma. Tension pneumopericardium is a cause of...
INTRODUCTION
Pneumopericardium, defined as the presence of gas in the pericardial sac, is a rare condition caused mostly by trauma. Tension pneumopericardium is a cause of hemodynamic instability; hence, it consists in a life-threatening situation and should be regarded in blunt chest trauma.
CASE REPORT
A 51-year-old male was victim of a 4m fall and burial. He was stable upon admission and presented a simple pneumopericardium and pneumomediastinum on CT. While being submitted to an upper digestive endoscopy he presented respiratory failure and had to be intubated, suddenly evolving to shock. He was promptly referred to the operating room; a pericardial window confirmed tension pneumopericardium and immediately hemodynamic stability was restored. A pericardial drain was placed and kept for 15days. He was discharged at the 18th day post-trauma after a satisfactory recovery at the trauma ICU.
DISCUSSION
Blunt thoracic trauma causes pneumopericardium by various mechanisms. Tension pneumopericardium is a possible outcome, probably related to positive-pressure ventilation. It leads to hemodynamic instability and requires immediate decompression and placement of a pericardial drain.
PubMed: 27266838
DOI: 10.1016/j.ijscr.2016.04.052 -
Thorax Aug 1976Spontaneous pneumopericardium is a relatively rare event, although cases have been recorded over the past 130 years. Many were associated with malignancy, trauma,...
Spontaneous pneumopericardium is a relatively rare event, although cases have been recorded over the past 130 years. Many were associated with malignancy, trauma, infection or as a complication of recent surgery. Attempts at surgical resolution have been infrequent and survival extremely rare. We describe a patient in whom pneumopericardium developed spontaneously and insidiously, probably being present for some weeks before hospital investigation. Surgical exploration revealed the cause to be a benign gastric ulcer without an hiatus hernia or other diaphragmatic defect. Repair was attempted but the patient died in the early postoperative period. From an extensive review of the literature it is clear that spontaneous perforation of a gastric ulcer into the pericardium must be less rare than some authors have suggested.
Topics: Humans; Male; Middle Aged; Peptic Ulcer Perforation; Pneumopericardium; Radiography; Stomach Ulcer; Tissue Adhesions
PubMed: 968805
DOI: 10.1136/thx.31.4.460 -
BMJ Case Reports Jul 2012
Topics: Aged; Diagnosis, Differential; Endoscopy, Gastrointestinal; Female; Hernia, Hiatal; Humans; Pneumopericardium; Rupture, Spontaneous; Tomography, X-Ray Computed
PubMed: 22778476
DOI: 10.1136/bcr-2012-006411 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023 -
Circulation Reports Apr 2023
PubMed: 37025941
DOI: 10.1253/circrep.CR-22-0061 -
Heart & Lung : the Journal of Critical... 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Mediastinal Emphysema; Pandemics; Pneumonia, Viral; Pneumopericardium; SARS-CoV-2
PubMed: 32980170
DOI: 10.1016/j.hrtlng.2020.09.006 -
Biomedical Papers of the Medical... Mar 2023Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and...
INTRODUCTION
Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and blood pressure can lead to difficulties in the detection of arterial bleeding from associated injuries while the increased venous pressure can increase the rate of bleeding.
CASE REPORT
This is the case of a patient after a car accident, with bilateral serial fractures, bilateral pulmonary contusion, bilateral pneumothorax, emphysema of the neck and chest, pneumomediastinum and pneumopericardium, and other injuries. During treatment, the patient developed a gradually progressing hemodynamic instability, resulting in pulseless electrical activity. Further progression of the case is detailed in the paper.
CONCLUSIONS
Tension pneumopericardium is a rare complication of a high-energy blunt thoracic trauma that manifests through hemodynamic instability. Its treatment requires early diagnosis and immediate decompression of the pericardial cavity, which should, where possible, be performed even before putting the patient on mechanical ventilation as ventilation bears a high risk of worsening the pneumopericardium due to the increased air pressure in the lungs. During diagnosis and treatment of associated injuries, we must bear in mind that the hemodynamic changes caused by pneumopericardium can mask typical signs of such injuries.
Topics: Humans; Pneumopericardium; Thoracic Injuries; Pneumothorax; Multiple Trauma; Respiration, Artificial
PubMed: 34747414
DOI: 10.5507/bp.2021.060 -
CMAJ : Canadian Medical Association... Feb 2023
Topics: Humans; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 36746478
DOI: 10.1503/cmaj.221137