COVID-19 pneumothorax ups mortality three-fold

Almost one in a hundred patients admitted to hospital with COVID-19 develop pneumothorax , a complication which increases mortality up to almost threefold, results from a  UK study reveal.

The observational study, led by Professor Stefan Marciniak from the Cambridge Institute for Medical Research, found pneumothorax occurred in 0.97% of 131, 679 patients admitted during the first and second waves of the pandemic in the UK.

The figures showed that COVID-19 related pneumothorax was associated with a worse prognosis, with the odds ratio (OR) for death 2.94 in non-critical care patients and 2.98 for critical care patients.

Some groups of people were more at risk of pneumothorax than others, the study published in the  European Respiratory Journal showed.

In patients on non-critical care wards, chronic pulmonary disease was associated with pneumothorax with an OR of 1.80. Former and current smokers were also at an increased risk of the complication, with an OR of 1.44 and 2.28 respectively.

The incidence of pneumothorax also appeared to be associated with the level of respiratory support patients received. In patients requiring no supplemental oxygen, only 0.16% (60/37,030) had  a pneumothorax. Of those requiring oxygen without pressure support 0.56% (396/70,609) had pneumothoraces.

Treatment with non-invasive respiratory support alone was associated with an incidence of 0.96% (137/14,251), while significantly more patients (6.1%, 195/3,182) who received  invasive ventilation also had a pneumothorax.

Patients who received both non-invasive respiratory support and invasive ventilation had the highest incidence of pneumothorax at 8.5% (491/5,749, p<0.0001).

The authors noted that due to the observational nature of the study meant that causality could not be determined.

“The place of non-invasive respiratory support requires further study, since those who failed to respond to this and then required invasive ventilation appeared at greater risk of pneumothorax than those who underwent early intubation and mechanical ventilation,” they wrote.

Commenting on the trial, Professor Marciniak told the limbic: “Doctors really do need to be aware of the risk of pneumothorax, as the association with COVID-19 does seem real and is associated with an increased risk of a poor outcome.”

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