The Relationship of Pneumothorax with Acute Respiratory Distress Syndrome and Mortality in Covid 19

Background: Pneumothorax is defined by the accumulation of air between the visceral and parietal pleura. The degree of collapse after rupture of the visceral pleura determines the clinic of the pneumothorax. Acute respiratory distress syndrome is an important lung disease responsible for morbidity and mortality in critically patients, including Covid-19 patients.

Aims: It was aimed to related pneumothorax with ARDS and mortality in Covid-19 patients hospitalized in the Intensive-care unit.

Study Design: This study was done retrospectively between 1 Sep 2020 and 31 Dec 2020 in Ersin Arslan Training and Research Hospital Covid Intensive-care unit.

Methodology: Patients older than 18 years of age, positive polymerase chain reaction test, with lung involvement in computed tomography and admitted in the Intensive-care unit were included in the study. Age, gender, comorbidities, severity of ARDS, presence and treatment of pneumothorax, hospital stays and mortality of the patients were retrospectively examined. Statistical analysis of the study was done with the Chi-square test.

Results: 79 of the patients were males (66.4%) and 40 females (33.6%). The mean age was 68.2 ± 1.93 (33-92) years.71.4% of them had a history of chronic illness. The order of comorbidities from most to least were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease Lung involvements in CT were 60.5% multifocal and 29.5% unifocal. ARDS severity were 36.9% mild, 39.5% moderate, and 23.6% severe. Pneumothorax was found in 10% of the patients. Surgical treatment (tube thoracostomy) was required in 58.3% of patients with pneumothorax. 68% of the patients were mechanical ventilated. The mean length of stays in the intensive-care unit were 9.9 ± 1.28 (1-38) days. The mortality rate was 41.1%.

Conclusion: According to this study, Covid-19 is seen more frequently in males and over 60 years of ages in patients admitted to the Intensive-care unit. Pneumothorax is more often in multifocal involvement of the lungs and moderate or severe ARDS. Pneumothorax is related with mortality in Covid-19.