Modified Closed Chest Drainage System for Safe Anaesthesia in Patients with COVID-19 Suspicion (original) (raw)
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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.
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.
Cardiology and Cardiovascular Medicine, 2021
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
Cervico-Thoracic Air Collections in COVID-19 Pneumonia Patients - Our Experience and Brief Review
Chirurgia, 2022
COVID-19 (boala Coronavirus 19), o nouă entitate clinică secundară infecţiei cu SARS-CoV-2, ar putea explica apariţia revărsatelor aeriene cervico-toracice (pneumotorax, pneumomediastin şi emfizem subcutanat). A fost analizat un studiu retrospectiv pe o perioadă de 8 luni a cazurilor dintr-un sigur centru care prezentau concomitent infecţie SARS-CoV-2 şi pneumotorax, pneumodiastin, emfizem subcutanat, singure sau asociate. Toţi pacienţii neintubaţi care au prezentat complicaţiile amintite mai sus au avut o evoluţie favorabilă după drenajul pleural, drenajul percutan şi/sau tratament conservator. Drenajul pleural s-a practicat la pacienţii cu pneumotorax; în cazurile cu pneumomediastin şi emfizem subcutanat asociat a fost necesară utilizarea de ace sau angiocatetere inserate subcutanat împreună cu masaj decompresiv manual. Tratamentul conservator a fost rezervat pacienţilor care aveau pneumomediastin şi disfuncţie respiratorie moderat-severă. Infecţia SARS-CoV-2 ar trebui inclusă în clasificarea etiopatogenica a pneumotoraxului, ca o posibilă cauză de pneumotorax secundar spontan pneumoniei COVID-19. Rata de supravieţuire a fost mică (18,75%), 4 pacienţi au fost vindecaţi, 2 au avut o evoluţie favorabilă iar 26 au decedat. Drenajul pleural, obligatoriu la pacienţii cu pneumonie COVID-19 complicată cu
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...
Indian Journal of Anaesthesia
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.
Case reports in anesthesiology, 2021
Introduction. Paediatric patients represent a small portion of the COVID-19 disease population. Nevertheless, the possibility of a paediatric patient requiring surgery, especially high-risk aerosol-generating surgery on the airway, while having the SARS-CoV-2 infection may potentially result in problems during the perioperative period due to concerns regarding patient, family, and staff safety. When unplanned and unrehearsed, this scenario may cause delays and efficiency issues. Our aim is to report on an 8-yearold patient with a foreign object lodged in the oesophagus with COVID-19 that required emergency surgery. Case Report. An 8year-old female patient came to the emergency room with a history of difficulty in swallowing for 12 hours before admission, having accidentally swallowed a metal coin while playing. She did not have any recent history of disease, but her parents had noticed that, for the previous 4 days, she had had a mild fever and dry cough. Her parents and other relatives in the house had no similar complaints, and they assured us they had not been in contact with any suspected or confirmed COVID-19 patients. Our goal was to create a safe paediatric anaesthesia environment with safe working conditions for the surgical team. In this case report, we will describe our approach to patient transport, parental presence, preventions of aerosol risk, personal protection, the anaesthesia induction technique, and postoperative management. Conclusion. Safe paediatric anaesthesia, especially in a high-risk aerosol-generating procedure, during the COVID-19 era requires consideration and preparation of both the patient and healthcare provider. Multidisciplinary team work with an emphasis on a systematic and planned approach is required to improve efficiency.
Journal of Cardiothoracic and Vascular Anesthesia, 2021
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.
Urgent Thoracotomy Operations In COVID-19 Era
Middle black sea journal of health science, 2021
Objective: This study has aimed to share the perioperative management practices and respective outcomes in patients; who underwent urgent thoracotomy due to traumatic hemothorax during the pandemic. Methods: In a single-center, 18 patients; who underwent urgent thoracotomy due to traumatic hemothorax in March 2020 to March 2021, were included in the study retrospectively. Patient data were retrieved from digital archive files. The initial evaluation was performed in the emergency room while wearing complete personal protective equipment. Patients were taken into the operating room under emergency conditions without waiting for the results of the nucleic acid tests performed on oropharyngeal and nasopharyngeal swabs. The operation was carried out by involving the minimum number of personnel. In the postoperative period, patients were followed up in a negative pressure intensive care room. Isolation measures were maintained until two novel coronavirus nucleic acid tests on oropharyngeal and nasopharyngeal swabs collected 48 hours apart were reported as negative. Results: During the one-year period in the COVID-19 pandemic, 18 patients were operated on with the indication of urgent thoracotomy. Of the patients, 14 were men (77.8%), and 4 were women (22.2%). Nucleic acid test results were negative in 17 patients (94.5%). The nucleic acid test result was reported positive in one patient (5.5%) for samples taken at the 48th hour. Nucleic acid tests were performed on the oropharyngeal and nasopharyngeal swabs obtained on the fifth and seventh days from the operation personnel. No novel coronavirus transmission occurred in the healthcare personnel. In the postoperative period, 15 patients (83.3%) were successfully treated and discharged from the hospital, but 3 patients (16.7%) died. No morbidity or mortality occurred due to COVID-19. Conclusion: Urgent thoracotomies can be successfully performed during the COVID-19 pandemic. Novel coronavirus transmissions can be avoided if relevant healthcare personel comply with isolation measures and use complete personnel protective equipment.