COVID-19 ventilator barotrauma management: less is more (original) (raw)
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Comparison of the tube thoracostomy techniques on treatment in COVID-19 patients with pneumothorax
Journal of Health Sciences and Medicine, 2022
Aim: Tube thoracostomy is an interventional procedure in which there is a high risk for the spread of COVID-19. In this study, we compare the tube thoracostomy procedures performed early on in the pandemic and those performed later after steps were taken in accordance with the new recommendations. Material and Method: It is a retrospective and single-center study. COVID-19 patients with spontaneous pneumothorax with indications for tube thoracostomy presented to our emergency department between March 10, 2020, and March 31, 2021. Based on the applied tube techniques, two groups were defined; group 1, patients who underwent classical tube thoracostomy, group 2, patients who underwent tube thoracostomy with the recommended preventive measures for COVID-19. The collected data were compared between the two groups. Results: 106 patients met the study criteria and were included in the study. The difference in the length of the tube duration time between the old or new technique was statis...
International Journal of Public Health Science (IJPHS), 2023
The incidence of pneumothorax is 10% of all COVID-19 patients and increases in patients who develop acute respiratory distress syndrome (ARDS) with mechanical ventilation, responsible for 24% of the population. As many as 60.7% of patients who have complications of pneumothorax or pneumomediastinum lead to mortality. This study was established to determine the potential of early tracheostomy in preventing the occurrence of pneumothorax and pneumomediastinum in COVID-19 and reducing mortality. This research was conducted as a descriptive study by case series of three COVID-19 patients in Jakarta, Indonesia in the span of 2021-2022. Tracheostomy performed within 10 days, did not develop a pneumothorax. Although, the patient did not have any comorbidities, age below 70 years, and coagulopathy problem, there was still a risk of recurrent pneumothorax post COVID-19 after tracheostomy. However, a tracheostomy is a procedure that poses an aerosol risk, so there is concern about the transmission of COVID-19 to medical personnel who perform it. Early tracheostomy has the potential to accelerate the resolution of COVID-19 disease in patients and has a positive impact on lung vitality. It is aimed to prevent hypoxic conditions and optimize the lung recruitment process. In addition, they did not experience complications from COVID-19 in the form of an air leak syndrome such as a pneumothorax or pneumomediastinum.
Background: Patients with COVID-19 are at risk of developing acute respiratory distress syndrome requiring invasive mechanical ventilation. Barotrauma in these patients often leads to clinically significant pneumothorax, which necessitates chest tube thoracostomy. However, given the mode of transmission of the severe acute respiratory syndrome coronavirus 2 virus and the aerosolizing nature of the procedure, special considerations and care must be taken to mitigate the exposure risks to health care personnel. This article discusses the risk mitigation strategies proposed and under review at the authors’ institution. Objective To identify and diagnosis Tube thoracostomy of COVID-19 positive patients during COVID-19 pandemic under thoracic surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Methods and materials A retrospective study was conducted in thoracic surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventeen patients included in our study. We included all COVID-19 cases admitted to ICU in the period between July 2020 to August 2021, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded. Results Total 17 patients required thoracic surgery consultation and management. Causes were pneumothorax: 05 cases (29.41%), traumatic hemothorax: 01 cases (5.88%), hydropneumothorax: 01 case (5.88%) and massive pleural effusion: 10 cases (58.82%). No complication after tube thoracostomy. 15 patient’s condition were improved in relation to oxygen demand and left hospital in good health and two patient died 3 days after tube thoracostomy who were in artificial ventilation and both patients had more than 81% lung involvement (fibrosis) diagnosed by CT scan of chest. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. Conclusion Non-iatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.
Recurrent pneumothorax in a COVID-19 patient: A case report
Respiratory Medicine Case Reports, 2020
An 88-year-old woman diagnosed with COVID-19 in Brazil presented with recurrent pneumothorax. She was under mechanical ventilation for 20 days because of acute respiratory distress syndrome (ARDS). Chest x-ray revealed right lung pneumothorax, which was treated with a pigtail chest tube leading to successful lung reexpansion. After 48 hours the patient developed an ipsilateral pneumothorax and a new tube thoracostomy under conventional chest tube under suction was performed and kept in place for 14 days. This brief report highlights that the conventional chest tube under suction procedures might be a good choice in Covid-19 patients.
Pakistan Journal of Medical Sciences
Objectives: COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients. Methods: The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneo...
Pneumothorax in Non-Ventilated COVID-19 Patients: A Case Series
International Journal of Health Sciences and Research, 2021
Coronavirus disease 19 (COVID-19) caused by SARS-CoV-2 has spread worldwide resulting in ongoing pandemic. Lung is the most common organ involved in COVID-19 with common radiological finding being ground glass opacities in peripheral distribution and lower lobes. 1 Pneumothorax is uncommon feature to observe with COVID-19. The exact incidence of this complication is still not known. In a report by Chen et al. 1% (one patient) had a pneumothorax among other radiographic features. 2 In a study published by Yang and colleagues in 92 deceased COVID-19 patients, one (1.1%) had a pneumothorax. 3 The mechanism of spontaneous pneumothorax in patients with COVID19 disease is proposed to be related to the structural changes in the lung parenchyma which include cystic and fibrotic changes leading to alveolar tears. In addition to the increase in intrathoracic pressure resulting from prolonged coughing and/or mechanical ventilation. 4,5 Pneumothorax further complicates the case of COVID-19. We ...
Protective measures undertaken during chest tube thoracostomy in COVID-19 outbreak
Indian Journal of Thoracic and Cardiovascular Surgery, 2020
Background Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that was first reported in China and has become a worldwide pandemic. Many surgical procedures are continuing to be performed during this state of pandemic as is thoracic surgery. We present six cases of tube thoracostomy in COVID-19 patients and the modifications to the routine surgical technique. Methods We serially attached two closed underwater drainage systems (CUDS) together and added a high-efficiency particulate air (HEPA) filter to the port of the second CUDS, because the intrapleural air, which passes through the CUDS into the air in intensive care unit (ICU), may contain high concentrations of 2019 novel coronavirus (2019-nCoV). Second, we attached the chest drain to the first CUDS in order to prevent the spread of virus during the placement of drain into the pleural cavity. Third, just before opening the parietal pleura, ventilation was put on standby mode and the endotracheal tube was clamped to prevent viral dissemination to the environment. Fourth, we covered the incision with a gauze sponge soaked with sterile saline solution during pleural entry, to prevent viral dissemination into the environment. Results There were a total of six patients enrolled in our study. All these patients were diagnosed with COVID-19. The surgical indication for the chest tube thoracostomy was tension pneumothorax in all six patents. All patients had lung expansion defects and subcutaneous emphysema after intervention. Unfortunately, all of them succumbed to COVID-19, despite best available treatment. There was no COVID-19 infection reported in the healthcare professionals during this study. Conclusions Thoracic surgical procedures may cause dissemination of high amounts of 2019-nCoV in the environment and thus are perhaps the most dangerous surgeries to perform. Variations in the thoracic surgical techniques are necessary in order to protect the healthcare providers from COVID-19.
COVID-19 Complicated by Spontaneous Pneumothorax
Cureus, 2020
Over the last few months, the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians across the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pneumothorax remains a relatively rare presentation with current literature indicating a rate of one percent. We describe a case series of three patients each of whom tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction testing of nasopharyngeal swab specimens and presented with pneumothorax. These patients were treated at the New York City Health and Hospitals (NYC H+H) system, a network of eleven hospitals in four different boroughs of New York City. None of these patients had a history of lung disease and one patient was a previous smoker. One out of three patients died. Inflammatory markers were noted to be elevated in each of these patients to levels that have been associated with severe COVID-19 infection. CT scans in these patients showed bilateral air space disease consistent with COVID-19 pneumonia and pneumothorax with other features including pneumomediastinum, subcutaneous emphysema, and pneumatoceles. This may indicate the underlying pathogenesis of pneumothorax in these patients to involve inflammation-induced pulmonary parenchymal injury and necrosis with subsequent development of air leaks into the pleural cavity, a mechanism similar to that noted in patients during the severe acute respiratory syndrome (SARS) outbreak in 2003. Conservative management with chest tube drainage or observation was adequate for two of three patients while one patient developed multi-organ system dysfunction and eventual death.
Pneumothorax and pulmonary air leaks as ventilator-induced injuries in COVID-19
2021
Figure 1. Chest X-ray (A) and computed tomography thoracic scan (B) of a 59-year-old male coronavirus disease 2019 (COVID-19) patient after 3 days of invasive ventilation. Ventilation occurred in pressure-control mode with the following parameters: peak inspiratory pressure, 27 cm H2O; positive end-expiratory pressure, 12 cm H2O; fraction of inspired oxygen, 0.6; inspiratory to expiratory ratio, 1:2; and respiratory rate, 16. The last measurement prior to the occurrence of pneumothorax was a plateau pressure of 25 cm H2O and static compliance of 43 L/cm H2O. Bilateral inhomogeneous parenchyma and consolidative aspects of the left lung were noted. The patient developed left pneumothorax and pneumomediastinum. On chest X-ray, subcutaneous emphysema is evident.