• Pablo Redruello-Guerrero, Marta Ruiz-Del-Pino, Carmen Jiménez-Gutiérrez, Paula Jiménez-Gutiérrez, Ana Carrascos-Cáliz, Alejandro Romero-Linares, Antonio Jesús Láinez Ramos-Bossini, Mario Rivera-Izquierdo, and Antonio Cárdenas-Cruz.
• Departamento de Medicina, Universidad de Granada, Granada, España.
• Med Intensiva. 2023 Apr 26.

ObjectivesTo assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW).DesignSystematic review with meta-analysis.SettingIntensive care unit (ICU).ParticipantsOriginal research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay.InterventionsData of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD.Main Variables Of InterestMortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis.ResultsData were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution.ConclusionsMortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD.© 2023 The Author(s).

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