Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.

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.)