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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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 languageEnglish
Article number2102522
Number of pages11
JournalEuropean Respiratory Journal
Issue number3
Publication statusPublished - 1 Sept 2022


  • Barotrauma
  • COVID-19
  • Mediastinal Emphysema
  • Pneumomediastinum
  • Pneumothorax
  • Subcutaneous Emphysema

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