Surgical management of tension pneumomediastinum in mechanically ventilated coronavirus disease 2019 patients

Introduction: Tension pneumomediastinum is an increasingly common condition since the COVID-19 pandemic's onset. It is a life-threatening complication with severe hemodynamic instability that is refractory to catecholamines. Surgical decompression with drainage is the key point of treatment. Various surgical procedures are reported in the literature, but no cohesive approach has yet been developed. Aim: The aim was to present the available options for surgical treatment of tension pneumomediastinum, as well as the post-interventional results. Materials and methods: Nine cervical mediastinotomies were performed on intensive-care unit (ICU) patients who developed a tension pneumomediastinum during mechanical ventilation. The age and sex of patients, surgical complications, pre- and post-intervention basic hemodynamic parameters, as well as oxygen saturation levels, were recorded and analyzed. Results: The mean age of patients was 62±16 years (6 males and 3 females). No postoperative surgical complications were recorded. The average preoperative systolic blood pressure was 91±12 mmHg, the heart rate was 104±8 bpm, and the oxygen saturation level was 89±6%, while the short-term postoperative values changed to 105±6 mmHg, 101±4 bpm, and 94±5%, respectively. There was no long-term survival benefit, with a mortality rate of 100%. Conclusions: Cervical mediastinotomy is the operative method of choice in the presence of tension pneumomediastinum allowing an effective decompression of the mediastinal structures and improving the condition of the affected patients without improving the survival rate.