Alveolar Air Leak Syndrome a Potential Complication of COVID- 19-ARDS - Single Center Retrospective Analysis.

Background: Alveolar air leak comprising of pneumothorax, pneumomediastinum, and subcutaneous emphysema in the ongoing COVID 19 pneumonia have been increasingly reported in literature. These air leaks were also recognized in the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and H1N1 viral pandemics. Here we review the incidence and outcomes of alveolar air leaks over 400 patients admitted to our tertiary care institution for moderate-severe COVID-19 pneumonia.

Methods: We performed a retrospective audit of moderate to severe COVID-19 cases admitted to our hospital. Patients who were recognized as either a spontaneous pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema were identified. Their clinical features and characteristics were thoroughly documented and clinical outcomes were gathered. Each case has been presented as a brief synopsis.

Results: During the audit period, we reviewed over 670 patients, out of these 419 patients required intensive care for moderate to severe disease. 10 patients developed Pneumothorax, pneumomediastinum, pneumopericardium and/ or subcutaneous emphysema - referred to as Alveolar Air leak syndrome; The incidence of alveolar air leak was found to be 2.39%. 6 patients did not survive the resultant complication.

Conclusion: Spontaneous alveolar air leaks are a rare but definite complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. ICU Clinicians must be alert about the diagnosis and treatment of this complication.