論文No2592
COVID-19 and pneumothorax: a multicentre retrospective case series
Anthony W. Martinelli, Tejas Ingle, Joseph Newman, Iftikhar Nadeem, Karl Jackson, Nicholas D. Lane, James Melhorn, Helen E. Davies, Anthony J. Rostron, Aldrin Adeni, Kevin Conroy, Nick Woznitza, Matthew Matson, Simon E. Brill, James Murray, Amar Shah, Revati Naran, Samanjit S. Hare, Oliver Collas, Sarah Bigham, Michael Spiro, Margaret M. Huang, Beenish Iqbal, Sarah Trenfield, Stephane Ledot, Sujal Desai, Lewis Standing, Judith Babar, Razeen Mahroof, Ian Smith, Kai Lee, Nairi Tchrakian, Stephanie Uys, William Ricketts, Anant R.C. Patel, Avinash Aujayeb, Maria Kokosi, Alexander J.K. Wilkinson, Stefan J. Marciniak
European Respiratory Journal 56 (5) 2002697; DOI: 10.1183/13993003.02697-2020 Published 19 November 2020
＜背景＞
気胸、縦隔気腫は入院を要するCOVID-19患者の合併症として報告されている。
我々はこれらの患者（非人工呼吸器患者を含む）の最大規模のケースシリーズを報告する。
＜方法＞
COVID-19と気胸あるいは縦隔気腫の診断に限った登録基準をみたす患者をイギリスの病院から後ろ向きに収集した。
2020年3月から6月までの患者を含んだ。
医療カルテから背景、放射線所見、血液データ、治療、生存の詳細を収集した。
＜結果＞
16のセンターから71名の患者が登録された。
60名が気胸（6名が縦隔気腫合併）、11名が縦隔気腫のみであった。
2名は気胸が経時的におこり、両側に順次おこり、全体の気胸の数が62エピソードであった。
臨床シナリオは気胸で病院受診、COVID-19で入院中に気胸あるいは
縦隔気腫を発症、挿管あるいは人工呼吸中に気胸／縦隔気腫を発症(ECMO施行ありなし）。
28日時点での生存は気胸 (63.1±6.5%)あるいは縦隔気腫(53.0±18.7%; p=0.854)で有意に差がなかった。
気胸の頻度は男性で多かった。28日時点での生存は性別で差がなかった
(males 62.5±7.7% versus females 68.4±10.7%; p=0.619)。
70歳以上の患者は若年者よりも28日生存が低かった
(≥70 years 41.7±13.5% survival versus <70 years 70.9±6.8% survival; p=0.018 log-rank)。
＜感想＞
COVID-19で気胸あるいは縦隔気腫が起こることがありますが、予後とは関連しなかったようです。
70歳以上では気胸発症時の予後が悪かったようです。
Introduction Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients).
Methods Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival.
Results 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5±7.7% versus females 68.4±10.7%; p=0.619). Patients aged ≥70 years had a significantly lower 28-day survival than younger individuals (≥70 years 41.7±13.5% survival versus <70 years 70.9±6.8% survival; p=0.018 log-rank).
Conclusion These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.