Patient Self-Inflicted Lung Injury and Spontaneous Air Leak Syndromes in Severe COVID-19: A Case Series and Scoping Review

This project combines a descriptive case series with a scoping review to explore patient self-inflicted lung injury (P-SILI) and spontaneous air leak syndromes in patients with severe COVID-19. Patient self-inflicted lung injury is a pathophysiological phenomenon associated with excessive spontaneous respiratory effort in acute hypoxemic respiratory failure, potentially leading to additional lung damage. During the COVID-19 pandemic, severe pneumonia was frequently accompanied by high respiratory drive, prolonged spontaneous breathing under non-invasive respiratory support, and the development of spontaneous air leak syndromes such as pneumomediastinum, pneumothorax, and subcutaneous emphysema. However, the clinical patterns linking these phenomena remain inconsistently described in the literature. The scoping review component of this project aims to systematically map existing evidence on P-SILI and spontaneous air leak syndromes in severe COVID-19, focusing on reported clinical manifestations, respiratory support contexts, and associated pulmonary complications. Owing to the heterogeneity of study designs and reporting approaches, a scoping review methodology was selected to clarify key concepts and identify gaps in current knowledge. In parallel, a descriptive case series of three patients with confirmed SARS-CoV-2 infection and severe hypoxemic respiratory failure is included to illustrate real-world clinical trajectories. These cases highlight the temporal association between excessive respiratory effort and the development of spontaneous air leak syndromes, complementing the findings identified in the scoping review. The expected outcome of this project is a comprehensive mapping of clinical patterns related to P-SILI and air leak syndromes in severe COVID-19, providing a structured overview of existing evidence and highlighting areas requiring further investigation. This work is intended to support clinical recognition of these phenomena and to inform future research rather than establish causal relationships or therapeutic recommendations.