Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limit...

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Bibliographic Details
Published in:BMJ case reports 2021-03, Vol.14 (3), p.e241809
Main Authors: Thein, Onn Shaun, Niazi, Muhammad, Ali, Abdisamad, Sahal, Adeel
Format: Article
Language:English
Subjects:
Aged, 80 and over
Antibiotics
Arthritis
Auscultation
Blood pressure
Cardiac arrhythmia
Case Report
Case reports
Conservative Treatment
Coronaviruses
COVID-19
COVID-19 - therapy
Diagnosis, Differential
Emphysema
Fatal Outcome
Female
Heart rate
Humans
Male
Mediastinal Emphysema - diagnostic imaging
Mediastinal Emphysema - etiology
Mediastinal Emphysema - therapy
Middle Aged
Noninvasive Ventilation - adverse effects
Osteoarthritis
Oxygen therapy
Palliative care
Pandemics
Patients
Pneumonia
Pneumothorax
Positive-Pressure Respiration - adverse effects
Pulmonary embolisms
Radiography
Respiratory distress syndrome
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Tomography, X-Ray Computed
Ventilators
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Summary:SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-241809