Management of spontaneous pneumomediastinum: Are hospitalization and prophylactic antibiotics needed?

Background Spontaneous pneumomediastinum is defined as the presence of free air in the mediastinum without any apparent concomitant factors or disease. It is uncommon but usually benign and self-limiting. Generally, patients with spontaneous pneumomediastinum are admitted to hospital, and occasionally, prophylactic antibiotics are administered to prevent mediastinitis. The purpose of this study was to describe practices concerning the feasibility of outpatient treatment and follow-up of spontaneous pneumomediastinum and the necessity of prophylactic antibiotics. Methods We conducted this study in a single emergency medical center located in Kobe, Japan. We retrospectively evaluated patients with spontaneous pneumomediastinum from January 2007 to December 2014. Spontaneous pneumomediastinum was defined as cases in which pneumomediastinum did not occur in the setting of positive pressure ventilation or severe trauma. All case records were carefully reviewed considering the demographic data, symptoms, precipitating events, diagnostic workup performed, use of prophylactic antibiotics, length of hospital stay, and complications. Results Thirty-four patients who satisfied the inclusion criteria were identified. Twenty-three patients (67.6%) were followed up on an outpatient basis, and 11 patients (32.4%) were admitted to the hospital, with a mean length of stay of 3.4 days. Prophylactic antibiotics were orally administered to 2 patients. None of the patients developed complications, such as tension pneumomediastinum, delayed pneumothorax, airway compromise, and mediastinitis. Conclusion Spontaneous pneumomediastinum is a benign condition presenting primarily in young adults, with an uneventful recovery. Therefore, patients may recover from this condition without admission or the need for prophylactic antibiotics.