Thoracic Air Leak Syndrome in COVID-19 Patients: An Emergent Complication

Background Sudden clinical deterioration in coronavirus disease 2019 (COVID 19) patients may be caused by thoracic air leaks. In this review, we aimed to identify the risk factors predisposing to the development of alveolar air leak and outcomes in COVID 19 patients. Method Analysis of 33 studies of COVID – 19 who developed air leaks, published between April 20 to Aug 27, 2020, reviewed. Result Twenty-one females (16.8%) and 104 males (83.2%) were included in this study. Their median age was 44.75 years, ranging from 27.5 to 60.0. Of the 125 patients, 100(80%) developed Spontaneous pneumothorax, 47 (37.6%) had pneumomediastinum, and 37 (29.6%) presented with subcutaneous emphysema. A chest tube was inserted in 63 (50.4%) patients, 97 (77.6%) received supplemental oxygen, 56 (44.8%) required mechanical ventilation, 64 (51.2%) were admitted to the Intensive Care Unit (ICU), 42 (33.6%) were admitted to the floor, and 35(28%) developed acute respiratory distress syndrome. The median length of hospital stay was 12 days (interquartile range=5.6–17.25), 57 (45.6%), patients were discharged with a median length of stay of 9 days (5.25-16.5), while mortality was reported in 29 patients (23.2%) after a longer hospitalization of 15 days (6.0-18.0). Of those who expired, only one was a smoker, and another had chronic obstructive pulmonary disease. Conclusion In COVID-19 disease, air leaks may cause potentially fatal outcomes even in formally stabilized non-smoker patients. Therefore, physicians should be aware of the development of occult air leak disease in rapidly deteriorating cohorts.