Acute respiratory distress syndrome and pneumothorax in COVID-19 patients

Background: Spontaneous pneumothorax is known as a fatal complication in patients with COVID-19. However, the exact pathogenesis of the spontaneous pneumothorax occurrence and its cause remains unknown. Accordingly, the present study examined 30 patients with acute COVID-19-induced respiratory failure who were under biphasic positive airway pressure (BIPAP) and medical ventilator machines. Methods: This study is a retrospective study and was performed on patients with COVID-19-induced acute respiratory failure who were admitted to the intensive care unit. The study population included 30 patients (10 patients with pneumothorax complication and 20 other patients without this complication). All study patient demographic data and device parameters (physiological parameters observed by the device) were collected and compared with each other. Results: Overall, 30 patients with COVID-19 and acute respiratory distress syndrome (ARDS) were selected during the 3 months from April to July 2020, with complications of spontaneous pneumothorax and emphysema detected in the collected chest X-ray images of 10 patients. In general, the results showed that p-plateau and p-peak parameters in the group with pneumothorax were significantly higher than the other group. Alternately, it was observed that static compliance for the group with pneumothorax was significantly lower than the uncomplicated group. Further, the mortality rates obtained were equal to 80% for the group with pneumothorax complication and 55% for the other group. Conclusion: Spontaneous pneumothorax in patients with ARDS and COVID-19 is a rare complication with a high mortality rate that occurs even in patients without intubation and patients undergoing BIPAP. Hence, if low static compliance and high pulmonary pressures are observed for patients, physicians should seek the complication diagnosis and treatment following changes in patients' symptoms.