COVID-19 News: UK Study Shows That A Significant Number Of Hospitalized COVID-19 Patients Suffer From Pneumothorax Or 'Punctured Lung'.
: British researchers led by the University of Cambridge, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust and various British hospitals and medical universities have found that as many as one in 100 patients admitted to hospital with COVID-19 will eventually develop a condition known as pneumothorax or 'punctured lung'. The condition was also found in individuals who were not at high risk or who were not yet hospitalized but had COVID-19.
The medical condition pneumothorax is basically collapsed lung and occurs when air leaks into the space between the lung and chest wall. This air pushes on the outside of the lung and makes it collapse. Pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. The condition typically affects very tall young men or older patients with severe underlying lung disease.
The study findings were published in the European Respiratory Journal. https://erj.ersjournals.com/content/early/2020/09/03/13993003.02697-2020
The study team observed that several patients with COVID-19 who had developed punctured lungs, even though they did not fall into either of these two categories.
Professor Dr Stefan Marciniak from the Cambridge Institute of Medical Research told Thailand Medical News, "We started to see patients affected by a punctured lung, even among those who were not put on a ventilator. To see if this was a real association, I put a call out to respiratory physicians and colleagues across the UK via Twitter. The response was dramatic; this was clearly something that others in the field were witnessing."
Dr Marciniak then obtained the appropriate ethical approvals and exchanged anonymised clinic information about 71 patients from around the UK. This led to the published research findings.
The seventy-one COVID-19 patients were from 16 centres of whom 60 patients had pneumothoraces (six also with pneumomediastinum), whilst 11 patients 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.
Pneumomediastinum is the abnormal presence of air or another gas in the mediastinum. The mediastinum is the center of the chest and is located between the lungs. Air can get stuck in this area because of trauma or leakage from the lungs or windpipe.
The 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 whilst 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).
Despite the fact that the study team is unable to provide an accurate estimate of the incidence of punctured lung in COVID-19, admissions data from the 16 hospitals participating in the study re
vealed an incidence of 0.91%.
Dr Marciniak, who is also a Fellow at St Catharine's College, Cambridge further added, "Doctors need to be alert to the possibility of a punctured lung in patients with COVID-19, even in individuals who would not be thought to be typical at-risk patients. Many of the cases we reported were found incidentally that is, their physician had not suspected a punctured lung and the diagnosis were made by chance."
Significantly, just under two-thirds or 63% of patients with a punctured lung survived. Individuals younger than 70 years tended to survive well, but older age was associated with a poor outcome ie a 71% survival rate among under 70s patients compared with 42% among older patients.
It was also observed that patients with a punctured lung were three times more likely to be male than female, though this may be accounted for by the fact that large studies of patients with COVID-19 suggest that men are more commonly affected by severe forms the disease.
The study findings however showed that the survival rate did not differ between the sexes.
Interestingly, patients who had abnormally acidic blood, a condition known as acidosis that can result from poor lung function, also had poorer outcomes in COVID-19 pneumothorax.
Co-researcher, Dr Anthony Martinelli, a respiratory doctor at Addenbrooke's Hospital added, “Although a punctured lung is a very serious condition, COVID-19 patients younger than 70 tend to respond very well to treatment. However older patients or those with abnormally acidic blood are at greater risk of death and may therefore need more specialist care."
The study team says that there may be several ways that COVID-19 leads to a punctured lung. These include the formation of cysts in the lungs, which has previously been observed in X-rays and CT scans.
The team concluded that the study findings suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and they encourage active treatment to be continued where clinically possible.
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