| COVID-19 patients develop Life-threatening complications like pneumomediastinum/
pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might
be imposed on the patient and the health system. The clinical features and outcomes of mechanically
ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and
subcutaneous emphysema has not been rigorously described or compared to those who do not develop
these complications. So a systematic review of studies conducted on this subject was carried out to better
manage these complications by investigating the underlying factors in COVID-19 patients.
Methods: The search was conducted between early January and late December 2020 in databases including
PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and
their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium,
and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based
on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of
the remaining studies were reviewed. Disagreements in the screening and selection of the studies were
resolved by consensus or through a third-party opinion.
Results: A total of 793 articles were retrieved through the literature search, and 99 studies conducted
on a total of 139 patients were finally included The patient mortality was found to have a significant
relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between
the patients’ death and chest tube insertion (P=0.2) or between the interval of time from the onset of
symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and
the mean difference observed was statistically significant (P=0.001).
Conclusion: With the expansion of our clinical understanding of COVID-19, recognition of the uncommon
complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn’t find a
causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death,
as it is limited by many variables such as included studies’ design, or incomplete outcome data especially
more information about the associated risk factors, we recommend performing more well-designed studies
to describe the pneumothoraxes› incidence, risk factors, and outcomes in COVID-19 patients. |