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Pneumothorax in Critically Ill COVID-19 Patients in the Indian Subcontinent

Anshul Singh
Anshul Singh
   | Jan 14, 2023
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Article Category: Original paper
Published Online: Jan 14, 2023
Page range: 8 - 15
DOI: https://doi.org/10.2478/rjaic-2022-0002
Keywords
© 2022 Anshul Singh, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Demographic profile

Variables Pneumothorax (N=18) No Pneumothorax (N=34) P-value
Gender (M/F) 15/3 21/13 0.109*
Age (Mean ± SD) 46.4 ± 13.5 53 ± 16.3 0.148¥
Diabetes 6 (33.3%) 10 (29.4%) 0.771*
Hypertension 6 (33.3%) 17 (50.0%) 0.250*
COPD 0 (0.0%) 1 (2.9%) 1.000
Asthma 0 (0.0%) 2 (5.9%) 0.539
Time of onset in days (Mean ± SD) 10.6 ± 11.0 5.2 ± 3.4 0.010#
CT severity score (Mean ± SD) 19.9 ± 3.5 19.0 ± 4.3 0.536¥
Invasive ventilation 4/18 2/34 0.166
PS 20.9 ± 2.8 18.3 ± 3.2 0.022¥
PEEP 9.7 ± 2.4 10.0 ± 2.1 0.623¥
FiO2 1.0 ± 0.1 1.0 ± 0.1 0.633¥
Duration of Ps support in days 16.4 ± 10.7 18.1 ± 10.5 0.648¥
Management: Chest pain/Conservative 9/9 1/33 <0.001

Various laboratory variables in both the groups at designated time intervals.

Variables Time of Collection Pneumothorax No Pneumothorax Unpaired t-test p-value Paired t-test p-value
Mean SD Mean SD Change from day of admission p-value Pneumothorax group SD Unpaired t-test p-value Change from day of admission p-value Non-Pneumothorax group
HB Day of Admission 12.9 2.5 12.6 1.6 0.607 - -
7 – 10 days 13.0 1.6 12.5 1.9 0.385 0.042 <0.001
15 – 20 days 12.5 2.8 12.5 1.8 0.946 0.152 <0.001
Day of Discharge 12.0 2.5 11.8 1.9 0.837 0.044 <0.001
TLC Day of Admission 10537.7 4412.4 10168.7 4402.5 0.801 - -
7 – 10 days 11724.7 5021.2 11889.7 4310.0 0.910 0.002 0.040
15 – 20 days 13358.3 8943.1 13704.8 5429.1 0.890 0.943 0.578
Day of Discharge 13642.9 6048.9 10803.6 4685.8 0.185 0.947 0.427
PLATELET COUNT Day of Admission 2.27 0.84 2.55 0.92 0.342 - -
7 – 10 days 2.55 0.78 3.03 1.11 0.144 0.388 0.013
15 – 20 days 2.49 1.33 2.64 1.10 0.721 0.928 0.508
Day of Discharge 2.52 0.91 2.56 0.95 0.916 0.777 0.730
ALBUMIN Day of Admission 3.4 0.3 3.4 0.4 0.789 - -
7 – 10 days 3.4 0.3 3.3 0.4 0.561 0.367 0.327
15 – 20 days 2.9 0.7 3.3 0.4 0.130 0.064 0.267
Day of Discharge 3.1 1.0 3.3 0.6 0.601 0.343 0.302
PH Day of Admission 7.39 0.06 7.37 0.07 0.314 - -
7 – 10 days 7.40 0.12 7.40 0.05 0.913 0.864 0.050
15 – 20 days 7.40 0.09 7.41 0.05 0.913 0.931 0.057
Day of Discharge 7.40 0.11 7.39 0.06 0.655 0.820 0.013
PCO2 Day of Admission 32.5 7.5 33.9 9.9 0.651 - -
7 – 10 days 39.1 14.5 34.5 7.9 0.184 0.217 0.736
15 – 20 days 43.1 14.8 36.4 11.7 0.157 0.081 0.950
Day of Discharge 45.5 16.9 36.6 7.9 0.041 0.020 0.874
PO2 Day of Admission 79.7 37.3 74.3 27.5 0.610 - -
7 – 10 days 72.5 41.3 81.7 25.9 0.374 0.285 0.262
15 – 20 days 90.8 30.5 92.3 39.7 0.911 0.851 0.201
Day of Discharge 64.2 24.0 93.1 34.9 0.035 0.110 0.059
HCO3 Day of Admission 20.8 4.8 21.9 3.6 0.434 - -
7 – 10 days 22.6 3.9 23.3 2.9 0.514 0.107 0.130
15 – 20 days 25.0 2.3 24.8 4.1 0.865 0.050 0.010
Day of Discharge 28.3 7.6 24.3 4.4 0.073 0.009 0.052

Kaplan Meier survival analysis reflecting the median survival time among pneumothorax/pneumomediastinum patients.

Median survival time among Pneumothorax patients
Estimate Standard Error 95% Confidence Interval
Lower Bound Upper Bound
7.0 days 0.707 5.614 8.386

Number of patients being administered oxygen therapy through various routes in both the groups.

Route of oxygenation Pneumothorax No Pneumothorax Chi-square test P-value
Count Column N % Count Column N %
BiPAP 0 0.0% 9 26.5% 0.005
CPAP 13 72.2% 15 44.1%
HFM 0 0.0% 7 20.6%
MV 4 22.2% 1 2.9%
NONE 1 5.6% 2 5.9%
Total 18 100.0% 34 100.0%

Laboratory values of inflammatory markers in both the groups at designated time intervals.

Variables Time of Collection Pneumothorax No Pneumothorax Mann–Whitney U test p-value Wilcoxon signed rank test p-value
Median Q1 Q3 Median Q1 Q3 Change from day of admission p-value Pneumothorax group Change from day of admission p-value Non-Pneumothorax group
IL 6 Day of Admission 41.1 27.8 63.3 12.6 3.7 59.6 0.147 - -
7 – 10 days 64.30 28.40 230.20 14.90 3.27 33.90 0.078 0.593 0.959
15 – 20 days 15.8 2.5 80.0 10.6 6.5 12.8 0.475 0.593 0.484
Day of Discharge 15.0 13.8 30.4 9.7 3.6 85.7 0.898 0.655 0.889
FERRITIN Day of Admission 1425.0 805.9 1650.0 916.5 462.0 1480.0 0.263 - -
7 – 10 days 1101.8 1101.8 1101.8 482.0 243.0 1141.0 0.800 0.317 0.109
15 – 20 days 1650.0 815.0 1650.0 1002.9 430.0 1321.0 0.202 0.317 0.285
Day of Discharge 579.0 181.9 1226.5 416.5 144.6 1121.0 0.886 0.180 0.317
D DIMER Day of Admission 897.0 131.0 1012.0 310.0 143.0 488.0 0.319 - -
7 – 10 days 543.0 368.0 5000.0 321.5 152.9 359.0 0.114 0.655 0.144
15 – 20 days 374.5 299.0 808.0 354.5 217.0 1285.0 1.000 0.180 0.866
Day of Discharge 87.9 48.9 282.0 565.0 414.2 904.5 0.114 0.109 0.593
CRP Day of Admission 79.0 18.0 101.0 40.0 11.0 61.8 0.062 - -
7 – 10 days 55.5 31.6 66.8 60.4 32.6 126.1 0.596 0.273 0.064
15 – 20 days 13.0 8.2 14.0 19.0 5.0 24.4 0.661 0.655 0.508
Day of Discharge 35.7 12.3 60.7 20.2 1.5 68.1 0.951 1.000 0.445
PCT Day of Admission 0.1 0.0 0.5 0.0 0.0 0.1 0.237 - -
7 – 10 days 0.1 0.0 0.3 0.1 0.0 0.1 0.727 0.180 0.893
15 – 20 days 7.2 0.0 13.0 0.0 0.0 0.3 0.381 0.317 0.786
Day of Discharge 0.0 0.0 0.0 0.1 0.0 0.2 0.154 1.000 1.000

Comparison of mortality between the groups.

Mortality Pneumothorax No Pneumothorax Chi-square test P-value
Count Column N % Count Column N %
Dead 13 72.2% 9 26.5% 0.001 RELATIVE
Alive 5 27.8% 25 73.5% RISK = 2.73 (95% C.I. 1.45–5.12)
Total 18 100.0% 34 100.0%
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