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

James Melhorn; Andrew Achaiah; Francesca M. Conway; Elizabeth M.F. Thompson; Erik W. Skyllberg; Joseph Durrant; Neda A. Hasan; Yasser Madani; Prasheena Naran; Bavithra Vijayakumar; Matthew J. Tate; Gareth E. Trevelyan; Irfan Zaki; Catherine A. Doig; Geraldine Lynch; Gill Warwick; Avinash Aujayeb; Karl A. Jackson; Hina Iftikhar; Jonathan H. Noble; Anthony Y.K.C. Ng; Mark Nugent; Philip J. Evans; Robert A. Hastings; Harry R. Bellenberg; Hannah Lawrence; Rachel L. Saville; Nikolas T. Johl; Adam N. Grey; Huw C. Ellis; Cheng Chen; Thomas L. Jones; Nadeem Maddekar; Shahul Leyakathali Khan; Ambreen Iqbal Muhammad; Hakim Ghani; Yadee Maung Maung Myint; Cecillia Rafique; Benjamin J. Pippard; Benjamin R.H. Irving; Fawad Ali; Viola H. Asimba; Aqeem Azam; Eleanor C. Barton; Malvika Bhatnagar; Matthew P. Blackburn; Kate J. Millington; Nicholas J. Budhram; Katherine L. Bunclark; Toshit P. Sapkal; Giles Dixon; Andrew J.E. Harries; Mohammad Ijaz; Vijayalakshmi Karunanithi; Samir Naik; Malik Aamaz Khan; Karishma Savlani; Vimal Kumar; Beatriz Lara Gallego; Noor A. Mahdi; Caitlin Morgan; Neena Patel; Elen W. Rowlands; Matthew S. Steward; Richard S. Thorley; Rebecca L. Wollerton; Sana Ullah; David M. Smith; Wojciech Lason; Anthony J. Rostron; Najib M. Rahman; Rob J. Hallifax

doi:10.1183/13993003.02522-2021

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

James Melhorn^*, Andrew Achaiah, Francesca M. Conway, Elizabeth M.F. Thompson, Erik W. Skyllberg, Joseph Durrant, Neda A. Hasan, Yasser Madani, Prasheena Naran, Bavithra Vijayakumar, Matthew J. Tate, Gareth E. Trevelyan, Irfan Zaki, Catherine A. Doig, Geraldine Lynch, Gill Warwick, Avinash Aujayeb, Karl A. Jackson, Hina Iftikhar, Jonathan H. NobleAnthony Y.K.C. Ng, Mark Nugent, Philip J. Evans, Robert A. Hastings, Harry R. Bellenberg, Hannah Lawrence, Rachel L. Saville, Nikolas T. Johl, Adam N. Grey, Huw C. Ellis, Cheng Chen, Thomas L. Jones, Nadeem Maddekar, Shahul Leyakathali Khan, Ambreen Iqbal Muhammad, Hakim Ghani, Yadee Maung Maung Myint, Cecillia Rafique, Benjamin J. Pippard, Benjamin R.H. Irving, Fawad Ali, Viola H. Asimba, Aqeem Azam, Eleanor C. Barton, Malvika Bhatnagar, Matthew P. Blackburn, Kate J. Millington, Nicholas J. Budhram, Katherine L. Bunclark, Toshit P. Sapkal, Giles Dixon, Andrew J.E. Harries, Mohammad Ijaz, Vijayalakshmi Karunanithi, Samir Naik, Malik Aamaz Khan, Karishma Savlani, Vimal Kumar, Beatriz Lara Gallego, Noor A. Mahdi, Caitlin Morgan, Neena Patel, Elen W. Rowlands, Matthew S. Steward, Richard S. Thorley, Rebecca L. Wollerton, Sana Ullah, David M. Smith, Wojciech Lason, Anthony J. Rostron, Najib M. Rahman, Rob J. Hallifax

^*Corresponding author for this work

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Abstract

Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalized with COVID-19 in the United Kingdom and describe factors associated with outcome.

Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.

Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58, 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p < 0.001) along with increasing age (p < 0.01) and diabetes mellitus (p = 0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.

Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

Original language	English
Article number	2102522
Number of pages	11
Journal	European Respiratory Journal
Volume	60
Issue number	3
DOIs	https://doi.org/10.1183/13993003.02522-2021
Publication status	Published - 1 Sept 2022

Keywords

Barotrauma
COVID-19
Mediastinal Emphysema
Pneumomediastinum
Pneumothorax
Subcutaneous Emphysema

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1183/13993003.02522-2021

Pneumomediastinum in COVID-19Final published version, 1.3 MBLicence: CC BY

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Melhorn, J., Achaiah, A., Conway, F. M., Thompson, E. M. F., Skyllberg, E. W., Durrant, J., Hasan, N. A., Madani, Y., Naran, P., Vijayakumar, B., Tate, M. J., Trevelyan, G. E., Zaki, I., Doig, C. A., Lynch, G., Warwick, G., Aujayeb, A., Jackson, K. A., Iftikhar, H., ... Hallifax, R. J. (2022). Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey. European Respiratory Journal, 60(3), Article 2102522. https://doi.org/10.1183/13993003.02522-2021

@article{6e2ed9a35f7d47d7a2516523125b5f1d,

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

abstract = "Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalized with COVID-19 in the United Kingdom and describe factors associated with outcome. Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality. Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58, 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p < 0.001) along with increasing age (p < 0.01) and diabetes mellitus (p = 0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality. Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.",

keywords = "Barotrauma, COVID-19, Mediastinal Emphysema, Pneumomediastinum, Pneumothorax, Subcutaneous Emphysema",

author = "James Melhorn and Andrew Achaiah and Conway, {Francesca M.} and Thompson, {Elizabeth M.F.} and Skyllberg, {Erik W.} and Joseph Durrant and Hasan, {Neda A.} and Yasser Madani and Prasheena Naran and Bavithra Vijayakumar and Tate, {Matthew J.} and Trevelyan, {Gareth E.} and Irfan Zaki and Doig, {Catherine A.} and Geraldine Lynch and Gill Warwick and Avinash Aujayeb and Jackson, {Karl A.} and Hina Iftikhar and Noble, {Jonathan H.} and Ng, {Anthony Y.K.C.} and Mark Nugent and Evans, {Philip J.} and Hastings, {Robert A.} and Bellenberg, {Harry R.} and Hannah Lawrence and Saville, {Rachel L.} and Johl, {Nikolas T.} and Grey, {Adam N.} and Ellis, {Huw C.} and Cheng Chen and Jones, {Thomas L.} and Nadeem Maddekar and Khan, {Shahul Leyakathali} and Muhammad, {Ambreen Iqbal} and Hakim Ghani and {Maung Myint}, {Yadee Maung} and Cecillia Rafique and Pippard, {Benjamin J.} and Irving, {Benjamin R.H.} and Fawad Ali and Asimba, {Viola H.} and Aqeem Azam and Barton, {Eleanor C.} and Malvika Bhatnagar and Blackburn, {Matthew P.} and Millington, {Kate J.} and Budhram, {Nicholas J.} and Bunclark, {Katherine L.} and Sapkal, {Toshit P.} and Giles Dixon and Harries, {Andrew J.E.} and Mohammad Ijaz and Vijayalakshmi Karunanithi and Samir Naik and Khan, {Malik Aamaz} and Karishma Savlani and Vimal Kumar and Gallego, {Beatriz Lara} and Mahdi, {Noor A.} and Caitlin Morgan and Neena Patel and Rowlands, {Elen W.} and Steward, {Matthew S.} and Thorley, {Richard S.} and Wollerton, {Rebecca L.} and Sana Ullah and Smith, {David M.} and Wojciech Lason and Rostron, {Anthony J.} and Rahman, {Najib M.} and Hallifax, {Rob J.}",

note = "Funding Information: Funding: The research was funded by the National Institute for Health Research Publisher Copyright: Copyright {\textcopyright} The authors 2022.",

year = "2022",

month = sep,

day = "1",

doi = "10.1183/13993003.02522-2021",

language = "English",

volume = "60",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

number = "3",

}

Melhorn, J, Achaiah, A, Conway, FM, Thompson, EMF, Skyllberg, EW, Durrant, J, Hasan, NA, Madani, Y, Naran, P, Vijayakumar, B, Tate, MJ, Trevelyan, GE, Zaki, I, Doig, CA, Lynch, G, Warwick, G, Aujayeb, A, Jackson, KA, Iftikhar, H, Noble, JH, Ng, AYKC, Nugent, M, Evans, PJ, Hastings, RA, Bellenberg, HR, Lawrence, H, Saville, RL, Johl, NT, Grey, AN, Ellis, HC, Chen, C, Jones, TL, Maddekar, N, Khan, SL, Muhammad, AI, Ghani, H, Maung Myint, YM, Rafique, C, Pippard, BJ, Irving, BRH, Ali, F, Asimba, VH, Azam, A, Barton, EC, Bhatnagar, M, Blackburn, MP, Millington, KJ, Budhram, NJ, Bunclark, KL, Sapkal, TP, Dixon, G, Harries, AJE, Ijaz, M, Karunanithi, V, Naik, S, Khan, MA, Savlani, K, Kumar, V, Gallego, BL, Mahdi, NA, Morgan, C, Patel, N, Rowlands, EW, Steward, MS, Thorley, RS, Wollerton, RL, Ullah, S, Smith, DM, Lason, W, Rostron, AJ, Rahman, NM & Hallifax, RJ 2022, 'Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey', European Respiratory Journal, vol. 60, no. 3, 2102522. https://doi.org/10.1183/13993003.02522-2021

TY - JOUR

T1 - Pneumomediastinum in COVID-19

T2 - a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey

AU - Melhorn, James

AU - Achaiah, Andrew

AU - Conway, Francesca M.

AU - Thompson, Elizabeth M.F.

AU - Skyllberg, Erik W.

AU - Durrant, Joseph

AU - Hasan, Neda A.

AU - Madani, Yasser

AU - Naran, Prasheena

AU - Vijayakumar, Bavithra

AU - Tate, Matthew J.

AU - Trevelyan, Gareth E.

AU - Zaki, Irfan

AU - Doig, Catherine A.

AU - Lynch, Geraldine

AU - Warwick, Gill

AU - Aujayeb, Avinash

AU - Jackson, Karl A.

AU - Iftikhar, Hina

AU - Noble, Jonathan H.

AU - Ng, Anthony Y.K.C.

AU - Nugent, Mark

AU - Evans, Philip J.

AU - Hastings, Robert A.

AU - Bellenberg, Harry R.

AU - Lawrence, Hannah

AU - Saville, Rachel L.

AU - Johl, Nikolas T.

AU - Grey, Adam N.

AU - Ellis, Huw C.

AU - Chen, Cheng

AU - Jones, Thomas L.

AU - Maddekar, Nadeem

AU - Khan, Shahul Leyakathali

AU - Muhammad, Ambreen Iqbal

AU - Ghani, Hakim

AU - Maung Myint, Yadee Maung

AU - Rafique, Cecillia

AU - Pippard, Benjamin J.

AU - Irving, Benjamin R.H.

AU - Ali, Fawad

AU - Asimba, Viola H.

AU - Azam, Aqeem

AU - Barton, Eleanor C.

AU - Bhatnagar, Malvika

AU - Blackburn, Matthew P.

AU - Millington, Kate J.

AU - Budhram, Nicholas J.

AU - Bunclark, Katherine L.

AU - Sapkal, Toshit P.

AU - Dixon, Giles

AU - Harries, Andrew J.E.

AU - Ijaz, Mohammad

AU - Karunanithi, Vijayalakshmi

AU - Naik, Samir

AU - Khan, Malik Aamaz

AU - Savlani, Karishma

AU - Kumar, Vimal

AU - Gallego, Beatriz Lara

AU - Mahdi, Noor A.

AU - Morgan, Caitlin

AU - Patel, Neena

AU - Rowlands, Elen W.

AU - Steward, Matthew S.

AU - Thorley, Richard S.

AU - Wollerton, Rebecca L.

AU - Ullah, Sana

AU - Smith, David M.

AU - Lason, Wojciech

AU - Rostron, Anthony J.

AU - Rahman, Najib M.

AU - Hallifax, Rob J.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalized with COVID-19 in the United Kingdom and describe factors associated with outcome. Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality. Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58, 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p < 0.001) along with increasing age (p < 0.01) and diabetes mellitus (p = 0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality. Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

AB - Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalized with COVID-19 in the United Kingdom and describe factors associated with outcome. Methods: A structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality. Results: 377 cases of pneumomediastinum in COVID-19 were identified from 58, 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p < 0.001) along with increasing age (p < 0.01) and diabetes mellitus (p = 0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality. Conclusions: Pneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

KW - Barotrauma

KW - COVID-19

KW - Mediastinal Emphysema

KW - Pneumomediastinum

KW - Pneumothorax

KW - Subcutaneous Emphysema

UR - http://www.scopus.com/inward/record.url?scp=85130742876&partnerID=8YFLogxK

U2 - 10.1183/13993003.02522-2021

DO - 10.1183/13993003.02522-2021

M3 - Article

C2 - 35144988

AN - SCOPUS:85130742876

SN - 0903-1936

VL - 60

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 3

M1 - 2102522

ER -

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

Abstract

Keywords

UN SDGs

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