277. Frequency of Pneumomediastinum and Pneumothorax in COVID-19 Patients: a Retrospective Cohort Study in a Community Hospital in Evanston, Illinois

Abstract Background Pulmonary barotrauma has been increasingly reported as a complication of COVID-19. Although a rare phenomenon, pneumomediastinum has been shown to be more prevalent in COVID-19 patients than in historical patients with adult respiratory distress syndrome. Methods We performed a Workbench report to identify 1046 patients admitted to our community hospital in Evanston, Illinois, with a primary diagnosis of COVID-19 from March 1, 2020, to January 31, 2022. Descriptive statistics were used to summarize the data. Results The incidence proportion risk was 3.15%. The median age was 66 years (interquartile range [IQR], 49.5 – 75.5 years), 84.8% (28/33) were males, 24.2% (8/33) were Asian, 18.2% (6/33) were White, 18.2% (6/33) were Latinx, and 9.1% (3/33) were long-term care facility residents. Pneumothorax was present in 21 patients (63.6%): unilateral 18/21 (54.5%); bilateral 3/21 (9.1%). Pneumomediastinum was present in 22 patients (66.7%). The median onset time of pneumothorax or pneumomediastinum after COVID-19 onset was 18 days (IQR, 11.5 – 25.5 days). Among 28 (84.8%) patients that required invasive mechanical ventilation (IMV), 6 (18.2%) developed pneumothorax or pneumomediastinum prior IMV; 5 (15.2%) patients developed pneumothorax or pneumomediastinum without IMV. The median onset time of pneumothorax or pneumomediastinum after IMV was 4 days (IQR, 0 – 8 days). Only 4 (9.1%) patients were ultimately discharged, 24 (72.7%) died, 2 (6.1%) were transitioned to hospice care, 3 (9.1%) were transferred to long-term care acute care, and 1 (3%) patient was transferred for ECMO. The fatality rate was higher compared to case reports available in the literature (5/23, 21.7% fatality rate. Table 1). Available data in the literature per case reports of pneumomediastinum and pneumothorax in COVID-19 patients Abbreviations: A-fib, atrial fibrillation; CAD, coronary artery disease; CPAP, continuous positive airway pressure, DM, type 2 diabetes; F, female; HLD, hyperlipidemia; HTN, hypertension; IMV, invasive mechanical ventilation; M, male; NC, nasal cannula; NIV, non-invasive ventilation; NRB, non-rebreather mask; OSA; obstructive sleep apnea; PMD, pneumomediastinum; PTX, pneumothorax; yo, years old. Conclusion The practitioners have to be alerted of the association of COVID-19 with pneumomediastinum, especially on the fact that this complication may happen in patients who never received mechanical ventilation or positive airway pressure support. Further research is needed into the exact pathogenesis, prevalence of this complication, and the impact on the clinical outcomes. Disclosures All Authors: No reported disclosures.