COVID-19 Associated Pneumothorax: Is Tube Thoracostomy Mandatory?
Taryne A. Imai, Shruthi Nammalwar, William Lee, Andrew Brownlee, Amirhossein P. Mahfoozi, Harmik J. Soukiasian.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
OBJECTIVE: Spontaneous pneumothorax has been reported as a rare complication of COVID-19 pneumonia. We report the largest single-institution case series to date and aim to describe the demographics and clinical characteristics of these patients. Additionally, we compare characteristics and outcomes of patients managed with a chest tube to those managed conservatively to guide future decisions in management.
METHODS: Retrospective review was performed of patients diagnosed with COVID-19 and pneumothorax between March 2020 and February 2021. Descriptive statistical analysis described the study population. Patients were divided into 2 groups based on management (chest tube vs. conservative) and studentís t-test was used to compare the groups.
RESULTS: 45 patients were included. Demographics and clinical characteristics are shown in Table 1. Mean interval between admission and pneumothorax development was 12 days. Of patients requiring mechanical ventilation, mean interval of 8.9 days between intubation and pneumothorax development was observed. Twenty-seven(60%) patients were managed with a chest tube and 18 (40%) were managed conservatively. 89% resolved their pneumothorax after chest tube placement. The chest tube group presented with larger pneumothoraces(3.5cm vs 2.2cm;p=0.01), higher BMI(31.2 vs 26.1;p=0.006), APACHE score(53.4 vs 35.2;p=0.04), and Tocilizumab use(33.3% vs 5.6%;p=0.03). Both groups were similar in age, steroid use, ventilator settings, and hospital length of stay (LOS). The chest tube group had a trend of higher mortality.
CONCLUSIONS: Chest tube placement should be considered in patients with higher BMI, severe APACHE scores, and pneumothorax size greater than 3cm. However, despite intervention, patients had similar LOS and a trend of higher mortality.
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