Spontaneous Air Leak Syndromes in COVID-۱۹: A Retrospective Analysis of ۱۲۴ Patients

Introduction: Air leak syndromes, including pneumothorax and pneumomediastinum, have emerged as important complications in patients with COVID-۱۹, often occurring even in the absence of invasive respiratory support. This study aims to characterize the clinical features, severity, and outcomes of COVID-۱۹ patients who developed spontaneous air leaks during their illness.Methods: In this retrospective cohort study, ۱۲۴ laboratory-confirmed COVID-۱۹ patients who developed spontaneous pneumothorax and/or pneumomediastinum between March ۲۰, ۲۰۲۰, and December ۳۱, ۲۰۲۲, were evaluated. Demographics, comorbidities, smoking status, clinical severity, air leak characteristics, interventions, and outcomes were recorded and analyzed using descriptive and comparative statistics.Results: The median age was ۶۵.۵ years, with ۷۰.۹۶% being male. Pneumothorax occurred in ۸۷.۱۰% of patients,  pneumomediastinum in ۱۶.۱۲%, and ۳.۲۲% had both conditions. None of the patients were on ventilatory support when the air leak occurred. The median time from COVID-۱۹ diagnosis to air leak development was seven days. High-grade (Grade ۳–۴) air leaks were identified in ۷۰.۲% of cases and were significantly more common in patients with severe or critical COVID-۱۹ (p = ۰.۰۰۲). Active smokers had higher rates of severe air leakage compared to non-smokers (۸۱.۰% vs. ۵۶.۱%, p = ۰.۰۱۱). Mechanical ventilation was subsequently required in ۹۵.۱۶% of patients. Tube thoracostomy was performed in ۸۲.۲۵% of cases, and the in-hospital mortality was ۸.۰۶%.Conclusions: Spontaneous air leak syndromes may occur early in the COVID-۱۹ disease course and are associated with greater clinical severity and smoking status. These findings challenge the traditional view of barotrauma-related air leaks and suggest that underlying alveolar fragility plays a key role. Further prospective studies are needed to refine early recognition and management strategies in this high-risk population.

کلیدواژه ها:

air leak syndromes ، COVID-۱۹ ، Pneumothorax ، Pneumomediastinum ، respiratory complications ، Spontaneous