Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review

Objectives: COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients. Methods: The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion. Results: A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients’ death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001). Conclusion: With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn’t find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies’ design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes› incidence, risk factors, and outcomes in COVID-19 patients. doi: https://doi.org/10.12669/pjms.38.3.5529 How to cite this:Shahsavarinia K, Rahvar G, Soleimanpour H, Saadati M, Vahedi L, Mahmoodpoor A. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5529 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Anesthesia for Laparoscopic Surgery: Anesthetic Management and Complications

Laparoscopic surgery results in physiologic changes that encompass multiple organ systems, with respiratory, cardiovascular and neurologic and splanchnic effects. Insufflation of the peritoneum results in reduced lung volumes, atelectasis, and endobronchial migration of the endotracheal tube. Pneumoperitoneum can result in changes to venous return, cardiac output and blood pressure. Hypercapnia due to carbon dioxide gas used in insufflation can reduce cerebral perfusion pressure. Complications during laparoscopic surgery often occur during port placement and creation of the pneumoperitoneum. Problems include injury to blood vessels during trocar entry, vascular injury in the pneumoperitoneum with limited surgical access, severe bradycardia and arrhythmias due to vagal stimulation from peritoneal stretching, subcutaneous emphysema, pneumothorax, gas embolism, and complications associated with steep Trendelenburg positioning. A thorough understanding of the physiologic changes associated with laparoscopic procedures and recognition of potential complications will facilitate in optimal patient care. This review contains 4 figures, 1 table and 52 references Keywords: Laparoscopy; laparoscopic surgery; carbon dioxide; pneumoperitoneum; capnothorax; general anesthesia; subcutaneous emphysema; insufflation

Oral Candidiasis with Subcutaneaous Emphyema Associated With Sari Following Post COVID 19: A Case Report

Background: Over the last few decades, the covid 19 has increased all over the world. More issues are likely to be observed as covid 19 rate increases. The major cause of morbidity and mortality is infection. Oral Candidiasis With Subcutaneaous Emphyema and SARI are very rare complications in Covid 19 patient. The final cause is infection, but sometimes it causes due to allergic or inflammatory reaction of the drugs. If it occurs after post covid 19 then creates very serious issues with the peoples health. Case Presentation: Here we are mentioning a very rare case of Oral Candidiasis With Subcutaneaous Emphyema and SARI after Covid 19 positive patient. In this case, on physical examination and investigation, it was found that, after covid 19 patient has developed Oral Candidiasis, Subcutaneous Emphysema , severe breathlessness, cough, fever, nausea, vomiting, throat infection and loss of appetide. To overcome this sudden issue, emergency exploratory medical and surgical treatment was done. During Covid 19 treament her HRCT Score was 21/25 and the infection was severe. There was no any sign of oral candidiasis, subcutaneous emphysema, or tissue or organ damage or no any other abnormality was detected during Covid 19 tratment. No bacterial growth or fungal growth observed on investigation. After some days and treatment of covid 19 the patient was developed a Oral Candidiasis and Subcutaneous Emphysema and SARI. The working diagnosis was finalized by doctors i.e. Oral Candidiasis With Subcutaneaous Emphyema and SARI. After expert medical management and excellent nursing care patient was discharged with full recovery. Conclusion: In this study, we mainly focus on expert medical management and excellent nursing care helped in managing the complicated case very nicely. All the patient response was positive for conservative and nursing management and after treatment the patient was discharged without any complications and satisfaction with full recovery.

Post-Partum Hamman’s Syndrome: A Case Report and Literature Review

Hereby, the case of a low obstetrical risk nulliparous 25-years-old woman, presenting with chest pain and subcutaneous emphysema on face, neck and sternum four hours after spontaneous vaginal delivery has been reported.