Eur Respir J: COVID-19 Mediastinal Emphysema: A Manifestation of Severe COVID-19 Pneumonia?

Background and purpose: Emphysema mediastinal (PTM) is the abnormal presence of air or gas in the mediastinum
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Spontaneous PTM is rare, occurring in approximately 1 in 33,000 hospitalized patients

Emphysema mediastinal (PTM) is the abnormal presence of air or gas in the mediastinal cavity

RESULTS: During the study period, 377 cases of mediastinal emphysema were identified among 58,484 inpatients with COVID-19 in 53 hospitals, representing an incidence rate of 0.
64%
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The overall 120-day mortality rate for COVID-19 mediastinal emphysema was 195/377 (51.

Table 1 Binary logistic regression model for predicting 120-day mortality from mediastinal air volume (all patients eligible for mechanical ventilation, n=315)
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In univariate analysis, all variables significantly associated with mortality were entered stepwise backward into the model

Table 1 Binary logistic regression model for predicting 120-day mortality from mediastinal air volume (all patients eligible for mechanical ventilation, n=315)

Figure 1 Sankey Plot of maximal respiratory support for all patients 4 hours before and 4 hours after diagnosis of mediastinal emphysema (n = 374)
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The mean fractions of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) at these levels of support are shown in the table below

Figure 1 Sankey Plot of maximal respiratory support for all patients 4 hours before and 4 hours after diagnosis of mediastinal emphysema (n = 374)

Figure 2.
Alluvial plot depicting the trajectories of 93 patients eligible for mechanical ventilation with continuous positive airway pressure (CPAP) at the time of diagnosis of mediastinal emphysema
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At diagnosis, there were no statistically significant differences in age, maximal fractional inspiratory oxygen (FiO2), or maximal positive end-expiratory pressure (PEEP) in patients who subsequently continued CPAP versus those who subsequently switched to oxygen or high-flow nasal oxygen (HFNO) difference

Figure 2.

Figure 3 Mediastinal emphysema coexisting with subcutaneous emphysema, tension pneumothorax, and use of intercostal thoracic drainage tubes (n = 377)
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Bilateral pneumothorax is caused by pneumothorax on both sides of the chest in the same patient

Figure 3 Mediastinal emphysema coexisting with subcutaneous emphysema, tension pneumothorax, and use of intercostal thoracic drainage tubes (n = 377)

Mediastinal emphysema may be a hallmark of severe COVID-19 pneumonia
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Most patients with confirmed mediastinal emphysema are not on mechanical ventilation at the time of diagnosis
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Original source: Melhorn J, Achaiah A, Conway FM, et al.
Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.
Eur Respir J 2022 Feb 10

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.
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