Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management.

Gandolfo, Corinna; Bonfiglio, Monica; Spinetto, Giulia; Ferraioli, Gianluca; Barlascini, Cornelius; Nicolini, Antonello; Solidoro, Paolo

BACKGROUND Pneumomediastinum (PNM) can develop as a severe complication of severe COVID 19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation. METHODS Our aim is to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series. RESULTS Twenty-one patients were diagnosed, two were treated with high flow nasal cannula, five with non invasive ventilation and four with invasive mechanical ventilation. In four cases PNM was massive PNM was often associated to subcuatneous emphysema; more rarely associated also with pneumothorax. Conservative management was the most used therapeutic strategy. CONCLUSIONS PNM should is s serious but not extremely rare complication of severe forms of pulmonary involvement of COVID 19. The clinician should consider this rare complication; moreover, we advise careful attention when clinicians start mechanical ventilation.