COVID-19 Pneumothorax in the United Kingdom:a prospective observational study using the ISARIC WHO clinical characterisation protocol

Abstract

Pneumothorax is an important complication of coronavirus disease 2019 (COVID-19) [1, 2]. Based on a series of 60 individuals, we previously estimated that 0.91% of people admitted to hospital with COVID-19 develop pneumothorax [1]. Males accounted for three quarters of those affected, and patients requiring noninvasive or invasive ventilatory support appeared at elevated risk. In a separate series of ventilated patients with COVID-19, barotrauma, defined as pneumothorax or pneumomediastinum, was found to be an independent risk for death [2]. During the pandemic, treatment strategies have evolved, influenced by large randomised controlled trials and clinical experience. Following the landmark results from the RECOVERY trial [3], dexamethasone became standard of care for patients requiring supplemental oxygen. Following the first UK wave between March and June 2020, use of noninvasive respiratory support became more common [4, 5]. Such changes could plausibly alter the incidence of pneumothorax caused by COVID-19. Indeed, a recent small study reported an increase in pneumothoraces in the second wave of COVID-19 in Italy, leading to speculation that dexamethasone use might have been causal

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http://creativecommons.org/licenses/by/4.0/ This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.

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DOI

https://doi.org/10.1183/13993003.00929-2021

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https://www.research.ed.ac.uk/en/publications/00da0eb1-7236-435b-9a97-ac65152f936a