• Corinna Gandolfo, Monica Bonfiglio, Giulia Spinetto, Gianluca Ferraioli, Cornelius Barlascini, Antonello Nicolini, and Paolo Solidoro.
• COVID-19 Intensive Care Unit, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy.
• Minerva Med. 2021 Dec 1; 112 (6): 779-785.

BackgroundPneumomediastinum (PNM) can develop as a severe complication of severe COVID-19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation.MethodsOur aim was to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series.ResultsTwenty-one patients were diagnosed, four were treated with high-flow nasal cannula, thirteen with non invasive ventilation and four with invasive mechanical ventilation. In five cases PNM was massive and associated to subcutaneous emphysema; more rarely PNM was associated with pneumothorax. Conservative management was the most used therapeutic strategy.ConclusionsPNM is a serious and not extremely rare complication of severe forms of pulmonary involvement of COVID-19. The clinician should consider this rare complication; moreover, we suggest being careful when clinicians start mechanical ventilation.

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