A comparative study evaluating the outcome of patients with pneumothorax diagnosed with COVID-19 in Iraq.

Abstract

Introduction: The Covid-19 pandemic has caused 34,161,721 confirmed cases and more than 1016,986 deaths worldwide so far. However, others can cause serious complications that increase the death rate. Acute respiratory distress syndrome (ARDS) is a complication of this new virus belonging to the family of coronavirus, known as SARS-CoV-2, which is currently the most common
complication for patients admitted to an ICU. Another complication, although less common but with a significant impact on the patient's development, is a spontaneous pneumothorax in patients with Covid-19, with a rate of 1-2%. The pathogenesis and pathophysiology of pneumothorax in connection with Covid-19 is still not completely clear, and the possible causes are the formation of bubbles, pneumocele, the inflammatory process itself, and barotrauma.

Objective: This paper aims to conduct a comparative study evaluating the outcome of patients with pneumothorax diagnosed with COVID19 in Iraq.

Patients and Methods: A prospective and archaeological cohort study was conducted evaluating the outcome of patients with pneumothorax diagnosed with COVID-19 in Marjan Medical City/Babylon, Iraq, by adequate sampling from 800 inpatient files admitted from June 2020 through March 2021. A statistical study was conducted for patients using the SPSS program. The study population includes every patient who was admitted and diagnosed with COVID-19 by PCR or chest CT scan. Files lacking the necessary data were excluded from the study. Pneumothorax was defined as any CXR findings according to ATS criteria.

Results and discussions: The main cause of primary spontaneous pneumothorax in patients with Covid-19 is rupture of subdural bullae or pneumocele with CT findings. The diffuse alveolar damage caused by the excessive inflammatory process caused by the large amount of cytokines released by the COVID-19 virus leads to a weakening of the airway walls, in addition to acute respiratory distress syndrome, which leads to an increase in intra-alveolar pressure that prepares the alveoli to rupture, causing them to rupture. Air leakage into the interstitial space. Follow up to previous studies; previous studies showed that men are more affected than women, as this was confirmed by our study, as it reached 308, or 61.5% of females, while the percentage of males reached 492, or 61.5%. In addition, this study has shown that most patients has gotten the treatment with the exception of two types of treatment where the patients have gotten which are Decadron and enoxaparin.

Conclusion: Pneumothorax is a primary cause of acute respiratory distress syndrome, which raises the chances of mortality. The problem with pneumothorax in SARS-CoV-2 patients is that despite respiratory therapy and the use of neuromuscular blockers, patients still have a high prevalence of pneumothorax. This increased frequency is due to the fact that individuals infected with SARS-CoV2 require a larger positive end-expiratory pressure (PEEP). When the cases were combined, it became clear that if a patient had a pneumothorax, the likelihood of mortality rose with time.