1. Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.
- Author
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Melhorn J, Achaiah A, Conway FM, Thompson EMF, Skyllberg EW, Durrant J, Hasan NA, Madani Y, Naran P, Vijayakumar B, Tate MJ, Trevelyan GE, Zaki I, Doig CA, Lynch G, Warwick G, Aujayeb A, Jackson KA, Iftikhar H, Noble JH, Ng AYKC, Nugent M, Evans PJ, Hastings RA, Bellenberg HR, Lawrence H, Saville RL, Johl NT, Grey AN, Ellis HC, Chen C, Jones TL, Maddekar N, Khan SL, Muhammad AI, Ghani H, Myint YMM, Rafique C, Pippard BJ, Irving BRH, Ali F, Asimba VH, Azam A, Barton EC, Bhatnagar M, Blackburn MP, Millington KJ, Budhram NJ, Bunclark KL, Sapkal TP, Dixon G, Harries AJE, Ijaz M, Karunanithi V, Naik S, Khan MA, Savlani K, Kumar V, Gallego BL, Mahdi NA, Morgan C, Patel N, Rowlands EW, Steward MS, Thorley RS, Wollerton RL, Ullah S, Smith DM, Lason W, Rostron AJ, Rahman NM, and Hallifax RJ
- Abstract
Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome., Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality., Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality., Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis., Competing Interests: Conflict of interest: James Melhorn has nothing to disclose. Conflict of interest: Andrew Achaiah has nothing to disclose. Conflict of interest: Francesca M. Conway has nothing to disclose. Conflict of interest: Elizabeth M. F. Thompson has nothing to disclose. Conflict of interest: Erik W. Skyllberg has nothing to disclose. Conflict of interest: Joseph Durrant has nothing to disclose. Conflict of interest: Neda A. Hasan has nothing to disclose. Conflict of interest: Yasser Madani has nothing to disclose. Conflict of interest: Prasheena Naran has nothing to disclose. Conflict of interest: Bavithra Vijayakumar has nothing to disclose. Conflict of interest: Matthew J. Tate has nothing to disclose. Conflict of interest: Gareth E. Trevelyan has nothing to disclose. Conflict of interest: Irfan Zaki has nothing to disclose. Conflict of interest: Catherine A. Doig has nothing to disclose. Conflict of interest: Geraldine Lynch has nothing to disclose. Conflict of interest: Gill Warwick has nothing to disclose. Conflict of interest: Avinash Aujayeb has nothing to disclose. Conflict of interest: Karl A. Jackson has nothing to disclose. Conflict of interest: Hina Iftikhar has nothing to disclose. Conflict of interest: Jonathan H. Noble has nothing to disclose. Conflict of interest: Anthony Y. K. C. Ng has nothing to disclose. Conflict of interest: Mark Nugent has nothing to disclose. Conflict of interest: Philip J. Evans has nothing to disclose. Conflict of interest: A. Hastings has nothing to disclose. Conflict of interest: Harry R. Bellenberg has nothing to disclose. Conflict of interest: Hannah Lawrence has nothing to disclose. Conflict of interest: Rachel L. Saville has nothing to disclose. Conflict of interest: Nikolas T. Johl has nothing to disclose. Conflict of interest: Adam N. Grey has nothing to disclose. Conflict of interest: Huw C. Ellis has nothing to disclose. Conflict of interest: Cheng Chen has nothing to disclose. Conflict of interest: Thomas L. Jones has nothing to disclose. Conflict of interest: Nadeem Maddekar has nothing to disclose. Conflict of interest: Shahul Leyakathali Khan has nothing to disclose. Conflict of interest: Ambreen Iqbal Muhammad has nothing to disclose. Conflict of interest: Hakim Ghani has nothing to disclose. Conflict of interest: Yadee Maung Maung Myint has nothing to disclose. Conflict of interest: Cecillia Rafique has nothing to disclose. Conflict of interest: Benjamin J. Pippard has nothing to disclose. Conflict of interest: Benjamin R. H. Irving has nothing to disclose. Conflict of interest: Fawad Ali has nothing to disclose. Conflict of interest: Viola H. Asimba has nothing to disclose. Conflict of interest: Aqeem Azam has nothing to disclose. Conflict of interest: Eleanor C. Barton has nothing to disclose. Conflict of interest: Malvika Bhatnagar has nothing to disclose. Conflict of interest: Matthew P. Blackburn has nothing to disclose. Conflict of interest: Kate J. Millington has nothing to disclose. Conflict of interest: Nicholas J. Budhram has nothing to disclose. Conflict of interest: Katherine L. Bunclark has nothing to disclose. Conflict of interest: Toshit P. Sapkal has nothing to disclose. Conflict of interest: Giles Dixon has nothing to disclose. Conflict of interest: Andrew J. E. Harries has nothing to disclose. Conflict of interest: Mohammad Ijaz has nothing to disclose. Conflict of interest: Vijayalakshmi Karunanithi has nothing to disclose. Conflict of interest: Samir Naik has nothing to disclose. Conflict of interest: Malik Aamaz Khan has nothing to disclose. Conflict of interest: Karishma Savlani has nothing to disclose. Conflict of interest: Vimal Kumar has nothing to disclose. Conflict of interest: Beatriz Lara Gallego has nothing to disclose. Conflict of interest: Noor A. Mahdi has nothing to disclose. Conflict of interest: Caitlin Morgan has nothing to disclose. Conflict of interest: Neena Patel has nothing to disclose. Conflict of interest: Elen W. Rowlands has nothing to disclose. Conflict of interest: Matthew S. Steward has nothing to disclose. Conflict of interest: Richard S. Thorley has nothing to disclose. Conflict of interest: Rebecca L. Wollerton has nothing to disclose. Conflict of interest: Sana Ullah has nothing to disclose. Conflict of interest: David M. Smith has nothing to disclose. Conflict of interest: Wojciech Lason has nothing to disclose. Conflict of interest: Anthony J Rostron has nothing to disclose. Conflict of interest: Najib M Rahman has nothing to disclose. Conflict of interest: Rob J Hallifax has nothing to disclose., (Copyright ©The authors 2022.)
- Published
- 2022
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