Spontaneous Air Leak Syndromes in COVID-19: A Retrospective Analysis of 124 Patients

Articles in Press

Document Type : Original Article

Authors

1 Department of Thoracic Surgery, Tekirdag Namik Kemal University Faculty of Medicine, Tekirdag, Turkey.

2 Department of Pulmonology, Tekirdag Namik Kemal University Faculty of Medicine, Tekirdag, Turkey.

3 Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkey.

10.22038/jctm.2025.88546.1491

Abstract

Introduction: Air leak syndromes, including pneumothorax and pneumomediastinum, have emerged as important complications in patients with COVID-19, often occurring even in the absence of invasive respiratory support. This study aims to characterize the clinical features, severity, and outcomes of COVID-19 patients who developed spontaneous air leaks during their illness.
Methods: In this retrospective cohort study, 124 laboratory-confirmed COVID-19 patients who developed spontaneous pneumothorax and/or pneumomediastinum between March 20, 2020, and December 31, 2022, 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 65.5 years, with 70.96% being male. Pneumothorax occurred in 87.10% of patients,  pneumomediastinum in 16.12%, and 3.22% had both conditions. None of the patients were on ventilatory support when the air leak occurred. The median time from COVID-19 diagnosis to air leak development was seven days. High-grade (Grade 3–4) air leaks were identified in 70.2% of cases and were significantly more common in patients with severe or critical COVID-19 (p = 0.002). Active smokers had higher rates of severe air leakage compared to non-smokers (81.0% vs. 56.1%, p = 0.011). Mechanical ventilation was subsequently required in 95.16% of patients. Tube thoracostomy was performed in 82.25% of cases, and the in-hospital mortality was 8.06%.
Conclusions: Spontaneous air leak syndromes may occur early in the COVID-19 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.

Keywords

References

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Journal of Cardio-Thoracic Medicine

Articles in Press, Accepted Manuscript
Available Online from 22 June 2025

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