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Case Series
Pneumomediastinum in COVID-19 critically ill patients: A case series of unusual complication from a Tunisian intensive care unit
1 Medical Intensive Care Unit, Ibn El Jazzar University Hospital, Kairouan, Tunisia
2 Pulmonology Department, El Jazzar University Hospital, Kairouan, Tunisia
Address correspondence to:
Jihene Ayachi
Road Iskander Makdouni n°17, Kairouan 3100,
Tunisia
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Article ID: 101326Z01DB2022
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Braiek DB, Mighri I, Zorgati H, Jazia RB, Kacem A, Ayachi J. Pneumomediastinum in COVID-19 critically ill patients: A case series of unusual complication from a Tunisian intensive care unit. Int J Case Rep Images 2022;13(2):50–57.ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) is a new rapidly emerging and ever-evolving disease that clinicians continue to detect new manifestations and complications daily since December 2019. Pneumomediastinum, a potentially life-threatening condition, is an uncommon complication of acute respiratory distress syndrome from viral infections. By presenting this case series, we highlight that pneumomediastinum (PM) can complicate the course of a severe COVID-19 infection.
Case Series: We identified four critically ill patients, two men and two women, aged between 50 and 70 years old. None of them had any underlying lung disease. On admission all cases were in acute respiratory distress syndrome. Three patients were under positive pressure ventilation both invasive (n = 2/4) and non-invasive (n = 1/4) at the time of the event; however, one patient had a spontaneous PM without any exposure to mechanical ventilation. Chest computed tomography scan (chest CT scan) was performed for all patients showing a pulmonary involvement estimated moderate (n = 3/4) to severe (n = 1/4), PM (n = 4/4) and subcutaneous emphysema (n = 2/4). For ventilated patients, PM was diagnosed 3 to 7 days after initiation of mechanical ventilation. The highest positive end-expiratory pressure was 10 cmH2O for patients receiving invasive mechanical ventilation, while 5 cmH2O for patient who had developed PM on non-invasive ventilation. The PM was managed by conservative therapy in all of the cases with reducing airway pressure.
Conclusion: Our findings suggest that PM is secondary to inflammatory response due to COVID-19 and mostly triggered by the use of positive pressure ventilation and it is associated with poor outcome in critically ill COVID-19 patients.
Keywords: COVID-19, Intensive care unit, Pneumomediastinum, Positive pressure respiration
SUPPORTING INFORMATION
Author Contributions
Dhouha Ben Braiek - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Imen Mighri - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Hend Zorgati - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Rahma Ben Jazia - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ameni Kacem - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jihene Ayachi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Dhouha Ben Braiek et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
