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Minerva Medica 2021 Jun 18

DOI: 10.23736/S0026-4806.21.07585-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management

Corinna GANDOLFO 1, Monica BONFIGLIO 1, Giulia SPINETTO 1, Gianluca FERRAIOLI 2, Cornelius BARLASCINI 3, Antonello NICOLINI 4 , Paolo SOLIDORO 5, 6

1 COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy; 2 COVID 19 Unit, General Hospital, Sestri Levante, Genova, Italy; 3 Hygiene and Health Medicine, General Hospital, Sestri Levante, Genova, Italy; 4 Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy; 5 Medical Sciences Department, University of Torino, Turin, Italy; 6 Division of Respiratory Diseases, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy


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BACKGROUND: Pneumomediastinum (PNM) can develop as a severe complication of severe COVID 19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation.
METHODS: Our aim is to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series.
RESULTS: Twenty-one patients were diagnosed, two were treated with high flow nasal cannula, five with non invasive ventilation and four with invasive mechanical ventilation. In four cases PNM was massive PNM was often associated to subcuatneous emphysema; more rarely associated also with pneumothorax. Conservative management was the most used therapeutic strategy.
CONCLUSIONS: PNM should is s serious but not extremely rare complication of severe forms of pulmonary involvement of COVID 19. The clinician should consider this rare complication; moreover, we advise careful attention when clinicians start mechanical ventilation.


KEY WORDS: COVID 19 related pneumonia; Severe respiratory failure; Pneumomediastinum

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