Respiratory disease, and treatment / thematic poster session pneumothorax as a sars-cov-2 outcome in previously healthy lungs: A single-center case-control retrospective study
Authors: Z. C. Tan, P. Sajja, R. Afable, A. M. Aung, M. Handoo, A. Fadairo-Azinge, S. Gehlot, I. Ladapo, K. Simon, R. Ayinla
Journal: American Journal of Respiratory and Critical Care Medicine (2021)

Introduction: SARS-CoV-2 infection ranges from self-limiting viral illness to acute respiratory distress syndrome. Diffuse alveolar injury from SARS-CoV-2 increases risk of alveolar rupture. Pneumothorax is a rare complication that has been documented in the literature. Objective: The study aims to investigate the significance of pneumothorax as a complication in patients with previously healthy lungs with acute respiratory failure due to SARS-CoV-2 infection. Methods: This is a case-control study of adult patients without existing lung disease managed for acute respiratory failure who developed pneumothorax as a complication of the disease. Patients with iatrogenic or traumatic pneumothorax, history of chronic lung disease, or previous pneumothorax were excluded. To avoid sample bias from excluding possible false-negatives, the control group (documented SARSCoV- 2 negative) also included patients from the same time period without SARS-CoV-2 testing and a remote unexposed group from a year before. Chi-square analysis was used to determine the relationship between the development of pneumothorax and SARS-CoV-2 infection, with the null hypothesis being no difference in the frequency of pneumothorax among positive SARS-CoV-2 patients and negative SARS-CoV-2 patients. Results: One-hundred-and-thirty charts of patients with symptoms of SAR-CoV-2 were reviewed. Thirty-four patients were documented to be SARS-CoV-2 positive, twelve of which had pneumothorax as a complication of the disease, ninety-one percent of whom were mechanically-ventilated. The control group had ninety-six patients with documented SARS-CoV-2 negative tests, were untested, or part of the historical group. Six patients from the control group had pneumothorax as a complication, two of which were negative for SARS-CoV-2, and three were untested. A Chi-square analysis yielded an X2 statistic of 17.7549 with a p-value of 0.000025.Discussion: Pvalue rejects the null hypothesis in 0.1, 0.05, and 0.01 levels of significance which means that there is a statistically significant difference in the frequency of pneumothorax between the case and control groups. Calculations were done under the assumption that those with negative SARS-CoV-2 tests were indeed free of the virus. There is a probability of underestimation as the tests used may have not been 100-percent sensitive. The four cases of pneumothorax in the control group may have been false-negatives as these patients exhibited imaging findings suggestive of SARS-CoV-2 pneumonia and were likely infected with the virus as well.Conclusion: Pneumothorax is a significant complication in patients without existing lung disease who develop acute respiratory failure and SARS-CoV-2 infection. It should be anticipated and suspected when clinical deterioration occurs especially in mechanically-ventilated patients. .