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World J Virol. Jul 25, 2022; 11(4): 176-185
Published online Jul 25, 2022. doi: 10.5501/wjv.v11.i4.176
Air leaks in COVID-19
Deven Juneja, Sahil Kataria, Omender Singh
Deven Juneja, Sahil Kataria, Omender Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Author contributions: Juneja D and Kataria S performed the majority of the writing, prepared the figures and tables, and performed data accusation; Singh O provided the input in writing the paper and reviewed the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: February 2, 2022
Peer-review started: February 2, 2022
First decision: April 8, 2022
Revised: April 11, 2022
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: July 25, 2022
Abstract

Coronavirus disease 2019 (COVID-19) continues to create havoc and may present with myriad complications involving many organ systems. However, the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected. There is a high incidence of air leaks in patients with COVID-19, leading to acute worsening of clinical condition. The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and un-derlying lung disease. The exact pathophysiology of air leaks with COVID-19 remains unclear, but multiple factors may play a role in their development. A significant proportion of air leaks may be asymptomatic; hence, a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality. These air leaks may even develop weeks to months after the disease onset, leading to acute deterioration in the post-COVID period. Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.

Keywords: Air leak, COVID-19, Pneumothorax, Pneumomediastinum, SARS-CoV-2, Subcutaneous emphysema

Core Tip: Air leaks are an under-recognized and under-reported complication of coronavirus disease 2019 (COVID-19). Air leaks may also develop in spontaneously breathing patients without any underlying risk factors. Because these leaks may be asymptomatic and may even develop weeks to months after the onset of disease, a high index of suspicion is warranted to ensure early diagnosis and timely intervention. Still, patients with air leaks have poorer overall outcomes with greater need for ventilatory support, longer length of hospitalizations, and higher mortality rates. A better understanding of its pathophysiology may help in preventing the development of air leaks and improve outcomes.