Case Series Pneumothorax in Mechanically Ventilated Patients with COVID- 19 Infection Raziye Ecem Akdogan, 1 Turab Mohammed , 1 Asma Syeda, 1 Nasheena Jiwa, 2 Omar Ibrahim, 2 and Rahul Mutneja 3 1 Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA 2 Department of Pulmonary and Critical Care Medicine, University of Connecticut, Farmington, Connecticut, USA 3 Department of Pulmonary and Critical Care Medicine, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA Correspondence should be addressed to Rahul Mutneja; rahul.mutneja@trinityhealthofne.org Received 3 November 2020; Revised 6 December 2020; Accepted 5 January 2021; Published 11 January 2021 Academic Editor: Mehmet Doganay Copyright © 2021 Raziye Ecem Akdogan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection. 1. Introduction Pneumothorax, defined by the presence of air in the pleural cavity with or without collapse of the lung, is often a life- threatening complication and a medical emergency [1]. It can be classified into spontaneous, iatrogenic, or traumatic pneumothorax based on the etiology [2]. Iatrogenic pneumo- thorax occurs from a complication of a diagnostic or thera- peutic intervention such as transthoracic-needle aspiration, placement of a central venous catheter, thoracentesis, lung, and or pleural biopsy, or barotrauma [3, 4]. During the coro- navirus disease 2019 (COVID-19) pandemic, an increase in pneumothorax incidence, especially among mechanically ventilated patients with COVID-19 infection, has been observed. The mechanical ventilation has deleterious effects on the lung, and pneumothorax is a known complication of lung ventilation [5]. Ventilation-related pneumothorax has been more commonly reported in the pediatric population due to immature lung mechanics [6, 7]. Although spontane- ous pneumothorax has been reported with infections, includ- ing COVID-19 [8, 9], the probability of pneumothorax increases from the combination of parenchymal injury from underlying infection and inflammatory response with addi- tional positive pressure ventilation. A study on 202 patients from Wuhan, 12 (5.9%) patients developed pneumothorax on mechanical ventilation [10]. Here, we present a case series of five patients with pneumothorax among 150 patients of COVID-19 pneumonia admitted to the intensive care unit at a tertiary care center. Information is summarized in Table 1. Hindawi Case Reports in Critical Care Volume 2021, Article ID 6657533, 8 pages https://doi.org/10.1155/2021/6657533