Published on May 14, 2021

AHMEDABAD: Animesh Mehta (name changed), 43, spent 34 days under hospitalization due to Covid-19. Due to low oxygen saturation, he had to be taken first on BiPAP and then ventilator. On Wednesday, he breathed his last at a private hospital in the city. The doctors treating him said he had a severe bout of coughing which proved to be fatal – his damaged lungs got ‘punctured’ due to the stress.

Dr Rajesh Chandra Mishra, a city-based critical care specialist and president-elect of Indian Society of Critical Care Medicine, said the condition is identified as spontaneous pneumothorax in medical parlance. “In general terminology, it can be understood as a leak of air from lungs to the chest cavity or thorax. If it happens between lungs near the heart, it’s called pneumomediastinum,” he said.

Reasons for this complication which is now being reported in ICUs across city is prolonged period on BiPAP which delivers high pressure oxygen to lungs and use of steroids.

Key reasons for this complication which is now being reported in ICUs across the city is prolonged period on BiPAP which delivers high pressure oxygen to the lungs and use of steroids. “When patients are given oxygen with peak inspiratory pressure (PIP), the positive pressure weakens the lungs in absence of natural inhalation-exhalation process. The lungs slowly lose its elasticity,” he said. “Moreover, if the heavy doses of steroids such as methylprednisolone and dexamethasone are administered, it weakens the outer layer of lungs, increasing the chances of rupture.”

International journals have indicated higher instances of spontaneous pneumothorax in Covid or Covid-recovered patients as majority patients with hypoxia where patients are given both oxygen with pressure and steroids.

Dr Anil Jain, director of EPIC Hospital, said that the number of patients after Covid recovery with such complications has increased manifold during this wave. “It has near-fatal complications in the majority of the cases. The lungs not only get stiffer but also brittle in such a way that a hard sneeze or prolonged coughing can rupture the lungs,” he said. “For its treatment, experts drain out the air from the diaphragm using a pigtail catheter. They try to ensure that the lungs don’t lose their elasticity completely.”

It’s also seen in some of the active Covid-19 patients, said Dr Amit Patel, a city-based pulmonologist. “The phenomenon is getting common among both active and former Covid patients due to the nature of the viral infection. It’s mostly seen in patients on BiPAP for long. If the patients’ condition allows, we advise and practice prone positioning in the early phase of infection,” he said.

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