Table 1.
Clinical details of patients with COVID-19 pneumomediastinum, divided by epidemic wave.
| Pt No. | Age, Sex | COVID-19 severitya | PM Extentb | LDH (U/L) | Ferritin (ng/mL) | D-dimer (ng/mL) | Breathings support | RRc | PEEP (CmH2O) | P/F Ratio (mm/Hg) | Vt (mL) | FiO2 | Predisposing factor | Predisposing factor location | Medications | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wave 1 | ||||||||||||||||
| 1 | 66, M | 5 | S | 603 | 1289 | 58000 | MV | NA | 10 | 220 | NA | 0.8 | Blebs/bullae | RUL, LUL | None | |
| 2 | 58, M | 5 | S,P | 283 | 969 | 1297 | MV | 22 | 12 | 99 | 550 | 1.0 | Diffuse emphysema | All lobes | Dex | |
| 3 | 56, M | 5 | S,P | 462 | 2423 | 745 | MV | 28 | 8 | 133 | 600 | 0.5 | None | – | None | |
| 4 | 79, M | 4 | M | 452 | 340 | 983 | HFNC | 21 | NA | 120 | NA | N | Bullous emphysema | RUL (5 cm) | Dex | |
| Wave 2 | ||||||||||||||||
| 5 | 19, F | 3 | S | 226 | NA | 129 | Unassisted | 19 | 260 | 280 | NA | 0.4 | Asthma | – | None | |
| 6 | 60, M | 5 | L | 723 | NA | 3492 | CPAP | 18 | 6 | 113 | NA | 1.0 | Blebs/bullae | RUL, LUL | Rem, Dex | |
| 7 | 79, M | 5 | S | 377 | 3992 | 5002 | MV | NA | 12 | 78 | NA | 0.9 | None | – | Dex | |
| 8 | 68, M | 4 | L | 405 | 666 | 1597 | CPAP | 20 | 8 | 111 | NA | 1.0 | Traction bronchiectasis | ML,RLL, LLL | Rem, Dex | |
| 9 | 38, M | 5 | S | 615 | NA | 2518 | CPAP | NA | 12.5 | 153 | NA | 0.6 | None | – | NA | |
| 10 | 54, M | 5 | S | 358 | 1250 | 1000 | CPAP | 24 | 10 | 132 | NA | 1.0 | None | – | NA | |
| 11 | 78, M | 5 | S | 335 | 1976 | 5740 | CPAP | 18 | 8 | 114 | 560 | 1.0 | Paraseptal emphysema | RUL,LUL, RLL | Dex | |
| 12 | 65, M | 5 | S,P | 416 | 1289 | 997 | MV | NA | 8 | 110 | 570 | 1.0 | None | – | NA | |
| 13 | 59, M | 4 | S | 413 | 3027 | 1373 | Unassisted | 22 | 8 | 160 | NA | 0.5 | None | – | None | |
| 14 | 90, M | 5 | S | 376 | 840 | 1156 | CPAP | NA | 7.5 | 148 | NA | 0.1 | Bullae/blebs | RUL, LUL, LLL, RLL | Dex | |
| 15 | 30, F | 5 | S,P | 356 | 103 | 13000 | CPAPd | 20 | 8 | 225 | 400 | 0.6 | None | – | Rem | |
| 16 | 70, M | 5 | S | 380 | 698 | 502 | MV | NA | 10 | 96 | 550 | 1.0 | ILD, traction bronchiectasis | RLL | Dex | |
Legend: CPAP: continuous positive airway pressure (helmet); HFNC: high-flow nasal cannulae; LDH: lactate dehydrogenase; LUL: left upper lobe; LLL: left lower lobe; ML: middle lobe; MV: mechanical ventilation; NA: not available: NTL: neutrophil-to-lymphocyte ratio; PEEP: positive end-expiratory pressure; PM: pneumomediastinum; RLL: right lower lobe; RR: respiratory rate.
All the other reported variables refer to the time when pneumomediastinum occurred. Medications legend: Dex: dexamethasone; Rem: remdesivir (other supportive medications with less specific relation to COVID-19 evolution and pneumomediastinum are not reported).
based on computed tomography scan [7], expressed in quintiles.
legend for extent of pneumomediastinum: L: light (detected on chest X-ray or at chest palpation), S: severe (obvious swelling extended to chest and neck); M: massive (extending to face and eyelid; required subcutaneous drainage); P: associated pneumothorax.
In some patient, respiratory rate refers to the last available record under spontaneous breathing, before orotracheal intubation and mechanical ventilation.
in this patient, intubation and mechanical ventilation was initiated very soon after occurrence of pneumomediastinum.