Spontaneous pneumomediastinum in patients with COVID-19 pneumonia


DOI: https://dx.doi.org/10.18565/therapy.2021.9.95-103

Yanushevich O.O., Levchenko O.V., Semenyakin I.V., Solodov A.A., Kebina A.L., Sycheva A.S., Grigorieva E.V., Pogosyan R.R.

A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia
Abstract. The diagnosis and estimation of risk factors for spontaneous pneumomediastinum (SPM) are of particular practical interest since the occurrence of this complication can significantly aggravate the course of COVID-19, while having vague clinical manifestations.
Purpose of the study – to determine the main clinical and laboratory characteristics, as well as risk factors for a severe course of the disease in patients with COVID-19 pneumonia, complicated by the development of SPM unrelated to invasive ventilation (IV).
Material and methods. The study included 130 patients (73 men and 57 women) with COVID-19 pneumonia who were diagnosed with SPM prior to episodes of invasive mechanical ventilation. The average age of the patients was 61±15,3 years. All patients had COVID-19 pneumonia on chest CT, confirmed by PCR testing. Upon admission to the hospital, demographic data, typical complaints, clinical variables and laboratory parameters were collected.
Results. SPM was detected in 130 patients, in 29 cases (22%), in addition to pneumomediastinum, unilateral and bilateral pneumothorax of various sizes developed. The most common comorbidities in the examined patients included: hypertension (71%), overweight and obesity (70%), coronary heart disease (20%), diabetes mellitus (15,4%), chronic obstructive pulmonary disease (9,2 %), cancer (9,2%), bronchial asthma (6,2%). Laboratory indicators of the examined patients had characteristic changes for COVID-19 pneumonia. The values of LDH, CRP, D-dimer and ferritin in blood plasma were increased. SPM was detected in the progression stage, with an increase in the volume of lung lesions before CT 3 (19,3%) and CT 4 (80,6%). The timing of SPM development from the onset of the disease was 13,0±7,3 days. Logistic regression showed that predisposing factors (OR 3,94; 95% CI: 1,13–13,6; p=0,031) and radiological severity (OR 6,63; 95% CI: 1,36–32,3; p=0,019) were independently associated with the risk of pneumomediastinum.
Conclusion. SPM in patients with COVID-19 who have not used invasive mechanical ventilation occurs in the progression stage, with an increase in the volume of lung lesions according to CT data to 3 and 4 degrees. The formation of SPM is associated with an increase in the severity of COVID-19 pneumonia, an increase in the frequency of use of invasive mechanical ventilation, and a higher risk of death.
Keywords: respiratory support, alveolar air leak syndrome, coronavirus pneumonia, pneumothorax, spontaneous pneumomediastinum, COVID-19, mechanical ventilation, pneumonia, computed tomography
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About the Autors

Oleg O. Yanushevich, MD, professor, academician of RAS, rector of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 20/1 Delegatskaya Str. Tel.: +7 (495) 684-49-86. E-mail: mail@msmsu.ru. ORCID: 0000-0003-0059-4980
Oleg V. Levchenko, MD, professor of RAS, vice-rector for medical work of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 20/1 Delegatskaya Str. Tel.: +7 (495) 970-11-45. E-mail: PROREKTOR-04@msmsu.ru. ORCID: 0000-0003-0857-9398
Igor V. Semenyakin, MD, associate professor of the Department of urology, chief physician of the Clinical Center COVID-19 of the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (968) 709-04-15. E-mail: dr.semeniakin@gmail.com. ORCID: 0000-0003-3246-7337
Alexander A. Solodov, MD, professor of the Department of neurosurgery and neuroresuscitation, deputy chief physician for anesthesiology and intensive care at the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia, anesthesiologist-resuscitator of the highest qualification category. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (906) 718-00-14. E-mail: docsol@mail.ru. ORCID: 0000-0002-8263-1433
Anastasia L. Kebina, assistant at the Department of therapy, clinical pharmacology and emergency medicine, deputy chief physician for medical work of the Clinical Center COVID-19 of the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (964) 558-22-64. E-mail: akebina@list.ru. ORCID: 0000-0002-7570-9650
Alexandra S. Sycheva, assistant at the Department of therapy, clinical pharmacology and emergency medicine, head of the 3rd Therapeutic Department of the Clinical Center COVID-19 of the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (915) 102-50-19. E-mail: docsycheva@gmail.com. ORCID: 0000-0001-8804-9914
Elena V. Grigorieva, MD, head of the medical office of radiation diagnostics of the Clinical Center COVID-19 of the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (967) 059-52-09. E-mail: iara333@yandex.ru. ORCID: 0000-0001-8207-7180
Roman R. Poghosyan, PhD, assistant at the Department of urology, head of the 10th Therapeutic Department of the Clinical Center COVID-19 of the University Hospital, A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 111398, Moscow, 1A/4 Kuskovskaya Str. Tel.: +7 (909) 986-87-87. E-mail dudeand1@mail.ru. ORCID: 0000-0002-5812-9179


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