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Case report
Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation
  1. Onn Shaun Thein1,2,
  2. Muhammad Niazi1,
  3. Abdisamad Ali1 and
  4. Adeel Sahal1
  1. 1Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  2. 2Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Onn Shaun Thein; shaunthein{at}gmail.com

Abstract

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.

Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.

We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.

  • pneumonia (infectious disease)
  • pneumonia (respiratory medicine)
  • COVID-19
  • CPAP

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-241809

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    Footnotes

    • Contributors OST drafted and reviewed the manuscript. MN drafted the manuscript. AA drafted the manuscript and obtained the consent. AS reviewed the manuscript and case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.