Kocaeli Med J. 2023; 12(3): 332-336 | DOI: 10.5505/ktd.2023.74875

Spontaneous Pneumothorax Incidence and Clinical Features in Non-Intubated COVID-19 Patients

Miktat Arif Haberal¹, Erkan Akar², Özlem Sengoren Dikis³, Mehmet Oguzhan Ay⁴, Melih Yüksel⁴, Halil Kaya⁴, Hakan Demirci⁵, Murat Ersal^6
1University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Thoracic Surgery, Bursa, Turkiye
²Tekirdag Namik Kemal University, School of Medicine, Department of Thoracic Surgery, Tekirdag, Turkiye
³University of Mugla Sitki Kocman, School of Medicine, Department of Pulmonary Medicine, Mugla, Turkiye
⁴University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Emergency Medicine, Bursa, Turkiye
⁵University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Bursa, Turkiye
⁶University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Anesthesiology and Reanimation, Bursa, Türkiye

INTRODUCTION: In this study, we aimed to review the pneumothorax incidence and results of patients receiving treatment due to COVID-19 infection.
METHODS: A total of 41,525 cases who were admitted to the emergency department between 01 April 2020 and 01 January 2021 with COVID-19 symptoms were reviewed. Of these patients 14,611 were hospitalized. Clinical and laboratory features of patients who had been diagnosed with spontaneous pneumothorax with PA chest radiography were evaluated and included in the study.
RESULTS: A total of 11 cases who were diagnosed with spontaneous pneumothorax and had a positive PCR test were included in the study. Of these cases, 8 were male and 3 were female. The age distribution was 50-84 and the mean age was 66.5 years. None of our cases had received invasive or non-invasive mechanical ventilation before diagnosis. The most common comorbidities were chronic obstructive pulmonary disease (6/11) and hypertension (2/11). Pneumothorax was right-sided in six cases and left-sided in four cases. It was concurrently bilateral in one case.
DISCUSSION AND CONCLUSION: Spontaneous pneumothorax is a rarely encountered condition in COVID-19 patients and its pathophysiological mechanisms are still unknown. The incidence of spontaneous pneumothorax in non-intubated COVID-19 patients is approximately 10-fold more frequent then normal population. This result demonstrates that spontaneous pneumothorax incidence secondary to COVID-19 infection is much higher than expected.

Keywords: COVID-19, pneumothorax, viral pneumonia, tube thoracostomy, lung disease

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Entübe Edilmemiþ COVID-19 Hastalarýnda Spontan Pnömotoraks Ýnsidansý ve Klinik Özellikleri

Miktat Arif Haberal¹, Erkan Akar², Özlem Sengoren Dikis³, Mehmet Oguzhan Ay⁴, Melih Yüksel⁴, Halil Kaya⁴, Hakan Demirci⁵, Murat Ersal^6
1Saðlýk Bilimleri Üniversitesi, Bursa Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Göðüs Cerrahisi Kliniði, Bursa, Türkiye
²Tekirdað Namýk Kemal Üniversitesi, Göðüs Cerrahisi Kliniði, Tekirdað, Türkiye
³Muðla Sýtký Koçman Üniversitesi, Týp Fakültesi, Göðüs Hastalýklarý Kliniði, Muðla, Türkiye
⁴Saðlýk Bilimleri Üniversitesi, Bursa Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Bursa, Türkiye
⁵Saðlýk Bilimleri Üniversitesi, Bursa Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Aile Hekimliði Kliniði, Bursa, Türkiye
⁶Saðlýk Bilimleri Üniversitesi, Bursa Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Anestezi ve Reanimasyon Kliniði, Bursa, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmada COVID-19 enfeksiyonu nedeniyle tedavi gören hastalarýn pnömotoraks insidansýný ve sonuçlarýný gözden geçirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 01 Nisan 2020 ile 01 Ocak 2021 tarihleri arasýnda COVID-19 semptomlarý ile acil servise baþvuran toplam 41.525 vaka incelendi. Bu hastalardan 14.611'i hastaneye yatýrýldý. PA akciðer grafisi ile spontan pnömotoraks tanýsý alan hastalarýn klinik ve laboratuvar özellikleri deðerlendirilerek çalýþmaya dahil edildi.
BULGULAR: Çalýþmaya spontan pnömotoraks tanýsý alan ve PCR testi pozitif çýkan toplam 11 olgu dahil edildi. Bu olgularýn 8'i erkek, 3'ü kadýndý. Yaþ daðýlýmý 50-84 ve ortalama yaþ 66,5 idi. Hiçbir olgumuz taný öncesinde invaziv veya non-invaziv mekanik ventilasyon almamýþtý. En sýk görülen komorbiditeler kronik obstrüktif akciðer hastalýðý (6/11) ve hipertansiyon (2/11) idi. Pnömotoraks altý olguda sað, dört olguda sol taraflýydý. Bir olguda eþ zamanlý olarak bilateral idi.
TARTIÞMA ve SONUÇ: Spontan pnömotoraks, COVID-19 hastalarýnda nadir görülen bir durumdur ve patofizyolojik mekanizmalarý halen bilinmemektedir. Entübe edilmemiþ COVID-19 hastalarýnda spontan pnömotoraks insidansý, COVID-19 dýþýndaki vakalarda bildirilen rakamlara göre yaklaþýk 10 kat daha sýktýr. Bu sonuç, COVID-19 enfeksiyonuna ikincil sekonder spontan pnömotoraks insidansýnýn beklenenden çok daha yüksek olduðunu göstermektedir.

Anahtar Kelimeler: COVID-19, pnömotoraks, viral pnömoni, tüp torakostomi, akciðer hastalýðý

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