| Abstract [eng] |
Abstract / Summary: Introduction: Spontaneous Pneumothorax (SP) and Spontaneous Pneumomediastinum (SPM) are potential complications of underlying lung diseases, especially forming cystic disorders of the lung with blebs or bullae. Spontaneous pulmonary barotrauma as Pneumothorax, Pneumomediastinum and subcutaneous emphysema is a rare, but severe complication in COVID-19. Methods: The literature research was performed using Key words: Barotrauma / Pneumothorax in COVID-19 patients, Pathophysiology, Radiologic Findings, Histopathology, Treatment. Research for meta analysis, systematic reviews, prospective studies, case studies, etc. Results: In COVID-19 patients, a dysregulated and hyper-activated immune response rather than the virus itself may cause a „Cytokine Storm“ (CS), leading to severe pneumonia and ARDS, thus heavily damaging the lung tissue and alveolar wall. Increased pressure from pronounced coughing and / or mechanical ventilation even in patients without preexisting lung diseases as COPD may lead to rupture of the alveolar wall and the development of pneumothorax / pneumomediastinum. In histologic sections of deceased COVID-19 patients, areas of destroyed alveolae were seen with build-up of cystic lesions. Furthermore, there were areas of no significant inflammation in neighbourhood of severely damaged lung tissue, possibly leading to unequal airway pressure and flow with overexpansion and subsequent shear forces in the small airways. In case of immunocompromised patients or as a result of Corticosteroid medication, bacterial or fungal secondary superinfection can cause lung abscess, pleural empyema and bronchopleural fistula, as shown in some case studies. Conclusions: All these mechanisms in COVID-19 pneumonia can lead to pneumothorax and / or pneumomediastinum, increasing the risk of in-hospital mortality by almost four times, especially among the elderly. Thus – if mechanical ventilation is required - strategies of „Protective Mechanical Ventilation“ with limitations of pressure and volume are important. In COVID-19-induced ARDS it is recommended to place chest tubes even in small pneumothoraces as lung capacity may be highly reduced. In case of persistent pneumothorax or if a bronchopleural fistula is suspected, minimal-invasive thoracic surgery / Video-Assisted Thoracic Surgery (VATS) may be required. |
