{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:23:40Z","timestamp":1787757820207,"version":"build-2784847793"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"\n INTRODUCTION:<\/jats:title>\n Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a universal pandemic in March 2020 by the World Health Organization and is a severe health issue with unprecedented morbidity and mortality rates. Both surgical and mediastinal emphysema have been seen in cases of critically ill COVID-19 patients in several hospitals in the Eastern Province of Saudi Arabia.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n This was a retrospective, cross-sectional, multicentric study involving several hospitals in the Saudi Arabian Eastern Province. Data were collected from intensive care units (ICUs) in these hospitals from March 2 to August 2, 2020. The inclusion criteria consisted of all patients who tested positive for SARS-CoV-2 and were admitted to a critical care unit.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n Thirty patients required thoracic consultation and management, including 26 males (81.3%) and 4 females (12.5%) (1:0.15) who developed surgical and mediastinal emphysema requiring thoracic surgery intervention. Most of the patients were on high ventilation settings, and the mean duration of ventilator support was 16.50 \u00b1 13.98 days. Two patients (6.3%) required reintubation. The median positive end-expiratory pressure (PEEP) was 12 \u00b1 2.80 cmH\n 2<\/jats:sub>\n O with a median FiO2 of 70% \u00b1 19.73. On average, thoracic complications occurred on day 3 (\u00b16.29 days) postintubation. Ten patients (33.33%) experienced a pneumothorax associated with surgical emphysema (SE), 1 patient (3.33%) presented with only mediastinal emphysema; 17 patients (56.66%) with only SE, and 1 (3.33%) had mediastinal emphysema associated with SE. We noted a correlation between the duration of ventilator support, the length of ICU stay (\n P<\/jats:italic>\n < 0.001), and the total length of stay (LOS) in the hospital (\n P<\/jats:italic>\n < 0.001). Total length of hospital stay showed significant association with the onset of complications (\n P<\/jats:italic>\n = 0.045) and outcomes (\n P<\/jats:italic>\n = 0.006). A significant association between PEEP and the duration of ventilator support was also evident with a\n P<\/jats:italic>\n value = 0.009 and the onset of complications (\n P<\/jats:italic>\n = 0.043). In addition, we found a significant association between the group with pneumothorax in combination with SE, and their outcomes, with a\n P<\/jats:italic>\n = 0.002.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n Surgical and mediastinal emphysema in the critically ill patients are usually attributed to barotrauma and high ventilations settings. During COVID-19 pandemic, these entities were seen and the pathogenesis was revisited and some attributed its presence to the disease process and destruction on lung parenchyma. The associated with extended LOS and delayed recovery in addition to poor prognosis were seen. Their presence is an indicator to higher morbidity and mortality.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/atm.atm_600_20","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T05:36:05Z","timestamp":1642052165000},"page":"51-58","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Surgical and mediastinal emphysema in critically ill COVID-19 patients"],"prefix":"10.4103","volume":"17","author":[{"given":"Yasser","family":"Aljehani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Auday A.","family":"Alkhunaizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifah A.","family":"Othman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan Abdullah","family":"Alqumber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousif","family":"Almubarak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Al-Musawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ibrahim","family":"Al Bazroun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khatoon","family":"Alshaikhmohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-7-20240830","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.jiph.2020.05.012","article-title":"Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: Case report","volume":"13","author":"Ucpinar","year":"2020","journal-title":"J Infect Public Health"},{"key":"R2-7-20240830","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1183\/09031936.04.00096404","article-title":"Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome","volume":"23","author":"Chu","year":"2004","journal-title":"Eur Respir J"},{"key":"R3-7-20240830","doi-asserted-by":"crossref","first-page":"096","DOI":"10.26502\/jsr.10020060","article-title":"A case of spontaneous pneumothorax in COVID-19 pneumonia","volume":"3","author":"Ayd\u0131n","year":"2020","journal-title":"J Surg Res"},{"key":"R4-7-20240830","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1111\/anae.15113","article-title":"Pneumomediastinum following intubation in COVID-19 patients: A case series","volume":"75","author":"Wali","year":"2020","journal-title":"Anaesthesia"},{"key":"R5-7-20240830","doi-asserted-by":"crossref","first-page":"541","DOI":"10.3348\/kjr.2020.0180","article-title":"Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia","volume":"21","author":"Sun","year":"2020","journal-title":"Korean J Radiol"},{"key":"R6-7-20240830","doi-asserted-by":"crossref","first-page":"e20208","DOI":"10.1097\/MD.0000000000020208","article-title":"SARS-CoV-2 pneumonia with subcutaneous emphysema, mediastinal emphysema, and pneumothorax: A case report","volume":"99","author":"Xiang","year":"2020","journal-title":"Medicine (Baltimore"},{"key":"R7-7-20240830","doi-asserted-by":"crossref","first-page":"e00806","DOI":"10.1016\/j.idcr.2020.e00806","article-title":"Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection","volume":"21","author":"Kolani","year":"2020","journal-title":"IDCases"},{"key":"R8-7-20240830","doi-asserted-by":"crossref","first-page":"taaa062","DOI":"10.1093\/jtm\/taaa062","article-title":"COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema","volume":"27","author":"Wang","year":"2020","journal-title":"J Travel Med"},{"key":"R9-7-20240830","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/S0140-6736(13)62634-3","article-title":"The Earth-Heart sign: A new diagnostic finding in a patient with tension pneumomediastinum","volume":"383","author":"Obeso Carillo","year":"2014","journal-title":"Lancet"}],"container-title":["Annals of Thoracic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/atm.atm_600_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:53:56Z","timestamp":1787756036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/atm.atm_600_20"}},"subtitle":["A multicentric experience"],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/atm.atm_600_20","relation":{},"ISSN":["1817-1737"],"issn-type":[{"value":"1817-1737","type":"print"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}