Pneumothorax in patients with COVID-19 pneumonia in the intensive care unit: an indicator of poor prognosis

Yıl 2025, Cilt: 6 Sayı: 1, 13 - 19, 14.02.2025

Onur Küçük , Fatih Seğmen , Semih Aydemir

https://doi.org/10.47582/jompac.1604018

Öz

Aims: The objective of this study was to investigate whether the incidence and development of pneumothorax in patients hospitalized in the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) pneumonia is associated with patient prognosis.
Methods: This retrospective, cohort, descriptive study was initiated following approval from the ethics committee. The study was conducted on patients with confirmed COVID-19 pneumonia admitted to the tertiary ICU between March 2020 and March 2022. Data were collected from the patient registry system and ICU files. The patients were divided into two groups: those who developed pneumothorax and those who did not. The factors associated with mortality in the ICU were evaluated by univariate analysis and multiple logistic regression analysis.
Results: The study included a total of 397 patients with confirmed cases of COVID-19 infection and pneumonia who were admitted to the ICU between March 2020 and March 2022. The mean age of the patients was 62±15 years. Of the patients, 56.1% were male. Pneumothorax was identified in 6.8% of patients. In addition to pneumothorax, six patients (1.5%) exhibited pneumomediastinum. The mortality rate was observed to be 40.5% among the total patient population. The mortality rate was 81.5% in the group with pneumothorax and 37.6% in the group without pneumothorax. The median time to mortality was 6 days (range 1–29 days) following the diagnosis of pneumothorax. Pneumothorax alone increased the likelihood of mortality in the ICU sevenfold (OR 7.3, 95% CI=2.70–19.75) and twofold when other variables were taken into account (OR 2, 95% CI=0.57-6.99).
Conclusion: Pneumothorax is a common and fatal complication affecting mortality in patients with COVID-19 pneumonia in the ICU, despite the use of protective ventilation strategies. Particular caution should be exercised in patients receiving respiratory support in the ICU and in patients with a severe inflammatory response.

Anahtar Kelimeler

Pneumothorax, pneumomediastinum, intensive care unit, prognosis, COVID-19

Etik Beyan

Approval was obtained from the ethics committee at the Yildirim Beyazit University, Yenimahalle Training and Research Hospital (date: 13/09/2023; approval number: E-2023-43). Yenimahalle Training and Research Hospital Ethics Committee did not require informed consent because the study was retrospective. All procedures followed were in accordance with the ethical standards (institutional and national) of the committee responsible for human experiments and the 1975 Declaration of Helsinki, revised in 2013.

Destekleyen Kurum

None.

Teşekkür

None.

Yoğun bakım ünitesinde COVID-19 pnömonisi olan hastalarda pnömotoraks: kötü prognozun bir göstergesi

Öz

Amaç: Bu çalışmanın amacı, koronavirüs hastalığı 2019 (COVID-19) pnömonisi nedeniyle yoğun bakım ünitesinde (YBÜ) yatan hastalarda pnömotoraks insidansı ve gelişiminin hasta prognozu ile ilişkili olup olmadığını araştırmaktır.
Yöntemler: Bu retrospektif, kohort, tanımlayıcı çalışma etik kurul onayının ardından başlatıldı. Çalışma, Mart 2020 ile Mart 2022 arasında üçüncü basamak YBÜ'ye yatırılan doğrulanmış COVID-19 pnömonisi olan hastalar üzerinde yürütüldü. Veriler hasta kayıt sisteminden ve YBÜ dosyalarından toplandı. Hastalar pnömotoraks gelişenler ve gelişmeyenler olmak üzere iki gruba ayrıldı. YBÜ'deki mortalite ile ilişkili faktörler tek değişkenli analiz ve çoklu lojistik regresyon analizi ile değerlendirildi.
Bulgular: Çalışmaya Mart 2020 ile Mart 2022 arasında YBÜ'ye yatırılan doğrulanmış COVID-19 enfeksiyonu ve pnömonisi olan toplam 397 hasta dahil edildi. Hastaların yaş ortalaması 62 ± 15 yıl idi. Hastaların %56,1'i erkekti. Hastaların %6,8'inde pnömotoraks tespit edildi. Pnömotoraksa ek olarak altı hastada (%1,5) pnömomediastinum görüldü. Toplam hasta popülasyonunda mortalite oranı %40,5 idi. Pnömotorakslı grupta mortalite oranı %81,5, pnömotorakssız grupta ise %37,6 olarak bulundu. Pnömotoraks tanısından sonra mortaliteye kadar geçen medyan süre 6 gündü (aralığı 1-29 gün). Pnömotoraks tek başına YBÜ'de mortaliteyi yedi kat, diğer değişkenler hesaba katıldığında ise iki kat arttırdı.
Sonuç: Pnömotoraks, koruyucu ventilasyon stratejilerinin kullanılmasına rağmen YBÜ'de COVID-19 pnömonisi olan hastalarda mortaliteyi etkileyen yaygın ve ölümcül bir komplikasyondur. YBÜ'de solunum desteği alan hastalarda ve şiddetli inflamatuar yanıtı olan hastalarda özellikle dikkat edilmelidir.

Anahtar Kelimeler

pnömotoraks, pnömomediastinum, yoğun bakım ünitesi, prognoz, COVID-19

Kaynakça

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