Pneumomediastinum, pneumothorax and pleural empyema in patients with COVID-19

Introduction. Since the beginning of the spread of Covid-19, publications have appeared regarding pneumomediastinum against the background of coronavirus infection, but the data in them are insufficient. Pneumomediastinum against the background of the spread of Covid-19 can be a source of serious concern for clinicians.The aim of the study is to present data on new, frequent observations of pneumomediastinum, combined with pneumothorax and hydropneumothorax in patients with Covid-19, with various clinical manifestations and course, as well as to determine treatment tactics.Materials and method. A study of the treatment results of 5301 patients with Covid-19, aged 19 to 104 years. Pneumomediastinum was confirmed by computed tomography. All patients with pneumothorax, pneumo-hydrothorax and empyema pleura were drained using the Pleuracan drainage system (B.Braun) or silicone drains, followed by active aspiration.Results. Pneumomediastinum did not require any interventions in any case, against the background of the treatment, the situation was resolved independently, as the air resorbed. In pneumothorax, active aspiration was carried out until the lung was completely straightened to achieve reliable sealing, from six days to two weeks. All 26 patients with pneumothorax who were on mechanical ventilation died, but in no casepneumothorax was the direct cause of death.Conclusion. Pneumomediastinum, especially in combination with pneumothorax, can complicate the course of severe coronavirus infection. Combination with pneumothorax requires drainage of the pleural cavity, at the same time, the pneumomediastinum needs only conservative management. In all cases the least traumatic and safest methods of treatment should be chosen.