Epidemiology

Physics

Internal medicine

Observational study

Pneumothorax

Disease

Coronavirus disease 2019 (COVID-19)

Infectious disease (medical specialty)

Incidence (geometry)

Complication

Optics

Surgery

Intensive care medicine

Mechanical ventilation

Pneumomediastinum

Pneumonia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Medicine

Heart & Lung

Pneumothorax has been frequently described as a complication of COVID-19 infections.In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax.Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of "COVID-19," "SARS-CoV-2," "pneumothorax," "pneumomediastinum," and "barotrauma" from January 1st, 2020 to January 30th, 2021.Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8-23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0-19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly.COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.

The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review