Epidemiological and outcome analysis of COVID-19-associated pneumothorax: multicentre retrospective critical care experience from Qatar

OBJECTIVES: To study the incidence, characteristics, treatment, associated risk factors and outcome of COVID-19-associated pneumothorax in intensive care unit (ICU). DESIGN: Retrospective observational data review. SETTING: A multicentre study from ICUs of three tertiary care hospitals in Qatar. PARTICIPANTS: 1788 patients with COVID-19 pneumonia requiring ICU admission from 1 March 2020 to 1 November 2020 were enrolled in this study. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was to identify the incidence of COVID-19-associated pneumothorax in patients requiring ICU admission. Secondary endpoints were to determine the associated risk factors, treatment, mortality and morbidity. RESULTS: 1788 patients from 3 centres were reviewed in the study. The total episodes of pneumothorax were 75. Pneumothorax occurred in 4.2% of the patients with COVID-19 pneumonia requiring ICU admission. The majority of the subjects were male (n=72, 96%). The mean age was 55.1 (±12.7 years). The majority of the subjects were nationals of South Asian countries and the Middle East and North Africa regions. 52% (n=39) of the patients were previously healthy without comorbidities before ICU admission. The recurrence rate was 9.3%. The median length of ICU stay was 28 days (20.5–45.8 days). After developing pneumothorax, the length of mechanical ventilation ranged from 6 to 32 days, with a median of 13 days. 44% of patients eventually ended up with tracheostomy. In-hospital mortality in the patients with COVID-19-related pneumothorax was 53.3% (n=40). The odds of mortality in patients with COVID-19 pneumonia with pneumothorax is 7.15 (95% CI 4.45 to 11.48, p<0.0001) compared with those who did not develop pneumothorax. This indicates pneumothorax is a potential independent risk factor associated with mortality in patients with COVID-19 pneumonia requiring ICU admission. CONCLUSIONS: Pneumothorax is a common complication in patients with COVID-19 requiring ICU admission, associated with poor prognosis and outcome. TRIAL REGISTRATION NUMBER: The study was approved by the Medical Research Centre (MRC) Qatar. (MRC-01-20-1116).