2025 Critical Care Congress Skip to main content
2025 Critical Care Congress Main banner
Final Program


Back

Pulmonary

Research Snapshot Theater: Pulmonary/Infectious Disease, Adult I

(1225) Risk Factors and Outcome of Pneumomediastinum in Ventilated COVID-19 Patients: A Retrospective Study

Tuesday, February 25, 2025
8:45am – 9:45am Eastern Time
Location: Connections Central - RST 15

    First Author(s)

  • Dawlat Khan, MD

    Sanford USD Medical Center
    Sioux Falls, South Dakota, USA

    • Co-Author(s)

  • MS

    Mustafa Shehzad, MD

    Resident
    Department of internal Medicine Hackensack university medical center
    Hackensack, New Jersey, United States

  • DS

    Dawood Shehzad, MD

    Resident
    Department of internal Medicine University of South Dakota
    Sioux Falls, South Dakota, United States

  • HC

    Hammad Chaudhry, MD

    Hospitalist Internal Medicine
    Sanford USD Medical Center
    Sioux Falls, South Dakota, United States

  • MA

    Muhammad Ahmad, MBBS

    Medical Student
    Khyber Medical College Pakistan, Pakistan

  • BA

    Baha Alabid, MD

    critical care physician
    Department of pulmonary critical care Medicine university of North Dakota
    Fargo, North Dakota, United States

Introduction: Pneumomediastinum (PNM) is a life-threatening condition with a significantly increased incidence during the COVID-19 pandemic, reaching 0.13%, nearly 6000 times higher than in the general population. Managing PNM is challenging as respiratory failure often necessitates mechanical ventilation, which can exacerbate PNM. Due to the lack of comprehensive evidence on risk factors and outcomes of PNM in COVID-19 patients, this study aims to fill that critical gap.

Methods: In this retrospective case-control study across two university hospitals we examined mechanically ventilated COVID-19 patients. We identified patients with PNM and matched them to similar patients without PNM from March 2020 to December 2023 (n=40, cases 21, controls 19). Data on multiple variables was collected and analyzed using t-tests, chi-square tests, and regression analysis.

Results: In our analysis, 52.5% of patients had PNM, while 47.5% did not, with a median age of 61.5 ± 24 years. The PNM group compared to non-PNM group exhibited higher mortality (64.71% vs. 35.29%, p=0.184), increased pneumothorax incidence (33% vs. 5%, p=0.032), longer time to tracheostomy (18 days vs. 14.5 days, p=0.421), and longer tracheostomy duration (52 days vs. 24 days, p=0.050). Postintubation tracheal complications were more frequent in the PNM group (47% vs. 10%, p=0.007), and acute respiratory distress syndrome was higher (71.4% vs. 36.8%, p=0.577). The PNM group also had a higher average PEEP (12.10 cm H2O vs. 10.70 cm H2O, OR 1.14). In contrast, the non-PNM group had higher steroid use (95% vs. 76%, p=0.101) and lower mean IPAP (25.47 cm H2O vs. 27.94 cm H2O, p=0.592). While not all differences were statistically significant, they are linked to notable clinical outcomes.

Conclusions: In conclusion, patients with PNM exhibit higher mortality, more tracheal complications, and longer time to and durations of tracheostomy. Risk factors include pneumothorax, higher PEEP, and increased inspiratory pressure. Although the rarity of PNM and small sample size constrained the statistical significance of some differences, these findings offer valuable clinical insights. Future research with larger sample sizes is necessary to validate these results and improve outcomes for COVID-19 patients with PNM.