Spontaneous pneumothorax associated with COVID-19 pneumonia: a single-centre retrospective study.

Spontaneous pneumothorax (SP) is a rare complication of COVID-19 pneumonia; it affects both intubated and non-intubated patients. The pathogenesis includes barotrauma and pneumatocele formation. In the following article, we present case series of 18 patients with COVID-19 associated pneumothorax - a detailed demographic and clinical analysis were performed. The study revealed that men were more affected than women, especially above the age of 55 years; whilst, the distribution of intubated patients and those with spontaneous breathing were equal. Importantly, tube thoracostomy was the preferred method of treatment. The lethal outcome was observed in all patients on mechanical ventilation, due to the severe course of the underlying disease. The occurrence of pneumothorax in patients with COVID-19 is associated with poorer outcome of the disease, especially in those placed on mechanical ventilation.

Surgical treatment of pneumothorax in patients with COVID-19 - results and management.

INTRODUCTION: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. AIM: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. MATERIALS AND METHODS: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. RESULTS: Seventeen of the patients were men and nine - women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. CONCLUSIONS: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.